HomeMy WebLinkAbout23-6436 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-6436 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 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 0745 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW 7TH ST BLOCK NO. e✓ 1000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a POWELL AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259193021 0 11
30
6� LAST NAME FISHER FIRSTNAME JEFFREY MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 520 BURNETT AVE S APT C CITy RENTON ST WA 2jp, 980572561 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 JJ I INJURY —, [NATURE OF INJURIES
1 H U SE CLASS 7 I CUTS ON HEAD/HANDS z❑
3
10 9❑ P1 ATNES# ARN3206 sTAr WAu N# 1 LNHM86S52Y681495
0 TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2002 MAKE LINC MODEL LS STYLE VEHICLE TOWED 0 TO
ffBLIN T,OVWkkRS VEHICLE 7 3 34
DAMAGE ILJI tSA1Wl6
13 REGISTERED OWNER INFO JEFFREYFISHER52013URNEIAVESAPTC RENTONINA98057 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILI V INSURANCE INSURANCE CO FARMERS 3 4
IN EFFECT &POLICY#
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3A0387729 FAIL TO YIELD MOTOR VEHICLE )o eorrom
15❑ STANDING
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U-NIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:6313168249
16 a
LAST NAME SELF III FIRST NAME JOHN MIDDLE I E
INITIAL
17❑ STREET ❑', 4815 FAUNTLEROY WAY SW APT 21 CITY SEATTLE ST WA ZIP 981164578 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. O6 _ 12 _ 1980 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE D22903C TAre WA VIN# 1(BCPYDEKXNZ195987
❑ 41
PLATE#
42
22❑ PLATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE CHEV MODEL SILVERA STYLE I VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO JOHN SELF 4815 FAUNTLEROY WAY SW APT 21 SEATTLEWA98116 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE &POINSURGY#E CO FIRST RATE 2017668184IN STOP 5
IETILE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED70710
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6436
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'
On 06/06/23 1 responded to a 2-vehicle injury/blocking collision at SW 7th and Powell Ave SW.
I contacted the driver of unit 2 who told me they were traveling eastbound in the #1 lane of SW 7th St
when unit 1 pulled out in front of him from northbound Powell St SW. The impact of the collision
caused heavy front-end damage to unit 2 but the driver says he was not injured. Unit 2 was
impounded by Bankers Towing.
I contacted the driver of unit 1, identified Jeffery A Fisher (dob 12-01-78) via his WA DL. Fisher told
me he was stopped at the stop sign (northbound Powell) waiting to turn left onto westbound SW 7th.
Fisher says he did see unit 2 approaching on eastbound SW 7th. Fisher says he entered onto SW
7th and was involved in a collision with unit 2. Fisher says he misjudged the speed of unit 2 but
believes he was "speeding." Fisher did complain of injury (head) and was treated and released at the
scene by Renton Fire. His vehicle sustained heavy front-end and side damage and was impounded
by Bankers towing.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Fisher via SECTOR under RCW 46.61.180 -Failure to Yield
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 06-06-23 12:11 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 6/16/2023 8:32:01 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED; 7:45 AM TIME POLICE ARRIVED 7:50 AM
PART I PAGE IT]OF
REPORT NO.! ED70710 CASE# 23-6436 DATE AND TIME 06/06/23 07:45
OF COLLISION
N
SW 7TH ST
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ua
J
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