HomeMy WebLinkAbout23-7702 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-7702 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 07 - 06 - 2023 1259 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE EXT BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e S 132ND ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:8324170332 0 4 30
6� LAST NAME NORTON FIRSTNAME TAJ MIDDLE J 1 2 31
INITIAL
STREET ❑✓ 7853 S 128TH ST TTLE WA
NEW ADDRESS S7 zIP', 98178 2
IF
SEA
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASSY 1 NATURE OF INJURIES z❑
3
10 3] P1 AT 14 CJB0152 STATE WA VIN# WAUBFGFF8F1062953
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 ] 34
13 2 2015 AUDI A3 DAMAGE vE8 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO TAJ NORTON 7853 S 128TH ST SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO GENERAL 53-WA 6178191
IN EFFECT &POLICY# 9TOP
15❑ vewCLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067341770
16 a
LAST NAME POWERS FIRST NAME PUl MIDDLE K
INITIAL
17❑ STREET ❑', 1010 SW 341ST ST CITY' FEDERAL WAY ST WA ZIP 980237895 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVERI # STATE WA ]SEX IF M D.C.B. 01 13 _ 1976 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE BOR0944 TATE WA VIN1 4T1BK1EB9EU082258
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2014 MAKE TOYT MODEL AVALON STYLE VEHICLE TOWED TO BLIN TOWED ev GOV HI 44
24❑ DAMAGE YES�/ NO GENE MEYERS YES NO
REGISTERED OWNER INFO PUI POWERS 1010 SW341STST FEDERAL WAY WA 98023 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 66504439IN I 5VEHICLELLY ❑ CITATION# CHARGE
25 GQ
LEGA YES N`E]
s � a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED82457
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7702
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling southbound on Renton AVE Ext approaching S 132nd ST. Unit 2 was in the left
turn lane planning to turn left from northbound Renton AVE Ext onto westbound S 132nd ST. Driver
1 states that they feared Unit 2 was going to pull out in front of him as it kept inching forward so he
applied his brakes. Driver 1 stated this caused his vehicle to veer to the left (east) so he tried to turn
further left to avoid striking Unit 2. Unit 1 attempted to pass Unit 2 on the left (east) side but could not
avoid Unit 2. The front passenger corner of Unit 1 struck the front passenger corner of Unit 2 in a
glancing blow but damaging both respective struck wheels. Unknown if Unit 2 initiated the left turn
causing Unit 1's actions to avoid the collision or if Unit 1's actions were unnecessary as Unit 2 would
not have caused a collision. This report is to document the circumstances of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-12-23 10:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/19/2023 2:36:46 PM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 4:08 Pry] TIME POLICE ARRIVED',1:13 PM
PART I PAGE IT]OF 3�
REPORT NO. ED82457 CASE# ' 23-7702 DATE AND TIME 07/06/23 12:59
OF COLLISION
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