HomeMy WebLinkAbout23-6699 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6699 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 06 - 1-- 2023 1646 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BL
SW SUNSET BLVD
OCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OFNACHES AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069927020 0 7 30
6� LAST NAME PATCH FIRSTNAME JAIDYN MIDDLE D 1 2 31
INITIAL
STREET ❑ 510 STEVENS AVE SW APT Q102 CITY RENTON ST WA 2jp, 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aTES� BYSO424 sTArI WAvIN# JT8J231C5S0024736
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. To
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE LEXS MODEL SC 300 STYLE CP VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 1995 DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO TERESA C.RLES 12201 AMBAUMBLVD SWAPT303 BURIEN WA 98146 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VE"'CLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3AO446363 OP MOT VEH W/OUT INSURANCE I o BorroM
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:2069927020
16 a
LAST NAME POPULUS FIRST NAME ERNEST MIDDLE R
INITIAL
17❑ NEW STREETR 14835 S
7 E 172ND PL CITY RENTON ST WA ZIP 98058 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX M M D.C.B. 11 22 _ 1970 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# ATM7594 TArE WA vIN# 1(B11H5SAXDF265469 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2003 MAKE CHEV MODEL MALIBU STYLE $D —FEHICLE
TOWED✓ NOO BLIN GENE MEYER YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE Z &POINSURGY#E CO STATE FARM 4154851-E18-47CIN IGVEHICLE
TOP
CITATION# CHARGE OTTOM
LEGALLY YES[Z NCE
25❑ Js a
7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MIN FLICK 12825 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73320
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6699
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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
BENJAMIN FLICK 06-12-23 06:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 6/24/2023 1:10:02 PM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED 4:46 PM TIME POLICE ARRIVED 5:03 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED73320 CASE# 23-6699 OF COLLISION
06/12/23 16:46
OF CbLLI510N
NARRATIVE
23-6699
On 06-12-23 at approximately 1646 hours I was working a marked Renton Police Department patrol
in full uniform in the city of Renton, County of King, State of Washington. I responded to a non-injury
collision on SW Sunset BLVD / Natches AVE SW.
Upon arrival I contacted the involved parties. Unit 1 driver was identified as Jaidyn Dante Patch
(DOB: 07/07/2002, via WA driver license). He had been driving unit 01 with license plate
WA/BYSO424. He told me that he had been proceeding westbound on SW Sunset Blvd when he did
not notice that unit 02 slowed for traffic and came to a stop in front of him due to a vehicle in front of
unit 02 that was stopped to turn left on Natches AVE SW. He collided with the rear bumper of unit 02.
1 contacted unit 2 driver Ernest Roger Populus (DOB 11-22-1970 via WA driver license) who had
been driving unit 02 with license plate WA/ATM7594. The damage to unit 02 was on the rear bumper
area, and the vehicles were still in contact with each other.
Unit 02 was towed by Gene Meyer (non-impound).
Neither party complained of any injuries.
I provided both parties with a business card and case number. Driver Patch told me that he did not
have any insurance at all and that he had been "trying" to get insurance.
I informed driver Patch that he would be receiving a citation via mail for following too closely and for
failure to display proof of insurance.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 06-12-2023 in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED73320 CASE# ' 23-6699 DATE AND TIME 06/12/23 16:46
OF COLLISION
U)
Naches Ave SW
t�
W' Not t0 shale
Unit 02
Unlit 01!;
PAGE 4 OF 4