HomeMy WebLinkAbout24-6641 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-6641 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F ❑ LOCAL AOENC 3
HIT IT&&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 0 2$
TRIBAL 1 OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION: 06 - 1-— 2024 1222 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
901 RAINIER AVE N BLOCK ST e✓
MILEPOST 900
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e BOEING AIRPORT ENTRY
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2069107877 30
5❑ LAST NAME FRIEDMAN, FIRSTNAME DANIELLE MIDDLE R 1 1 2 31
INITIAL
STREET ❑, 2905 S ADAMS ST,SEATTLE WA, CITY SEATTLE ST WA ZIP 98108 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 12 — 23 — 1976 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ pj ATE 14 BVL1864 STATE WA u N# JTDKN3DU8B5303140
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. A'RLR. 1 5 33
12❑ VIN#' VIN#.
:: FROM TO
❑ VEH.YEAR 2011 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 TOYT PRIUS 4C DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 4092666314 3
IN EFFECT &POLICY# 9TOP
vewoLe 1 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL PEDESTRIAN PROPERTY THR OLD MET PHONE
UNIT VEHICLE ❑ cvcLE ❑ ❑ OWNER [:]EA.
No ,/ D:4253549258
16 a
LAST NAME PENDERGAS FIRST NAME RAYMOND MIDDLE G
INITIAL
17❑ STREET ❑', 6232 NE 182ND ST,KENMORE WA, CITY' KENMORE ST WA ZIP 98028 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs❑NoF YES❑NO❑
19 DRIVE # STATE SEX M M .O.B. 10 _ 08 _ 1954 39
ON DUTY❑ STATUS 1 AIRBAG RESTR EJECT 3 WEB SET 5 INJAUSRY 5 [NATURE OF INJURIES
LEFT HIP,LEFT LEG,AND LEFT HAND 40
❑21❑ LICENSE TATE VI 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
�LEGA—
❑ ,.I—I CITATION# CHARGE i o BOTTOM
YES N
25 'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 4 4 SI TAMAIVENA 12788 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF01591
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6641
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SALAZAR SANDRA M
(LAST FIRST,
ADDRESS&PHONE# C.0
.B.
6232 NE 182ND ST,KENMORE WA, KENMORE WA 98028 4259411452 SEX F MMDOYyry 04 - 07 - 1954
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET NJURY NATURE OF INJURIES
❑ O SOS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) MAZIQUE MARC A
ADDRESS&PHONE# D O B
1705 S STEVENS ST,APT 304,S SEATTLE WA 98144 2068510062 SEX M MMDDYVY,04 _ 15 _ 1973
PASSENGER []WITNESSZ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIRST,MIDDLE INITIAL) DOUANGDALA SIENGKHAM
AooREss&PHONE# 4618 S OTHELLO ST,SEATTLE WA SEATTLE WA 98118 2069315435 SEX F D.O.B. 12 _ 07 _ 1976
MMDDYYYY
PASSENGER WITNESS Z UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
SULIASI TAMA/VENA 06-23-24 05:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 8/2/2024 6:45:39 AM
BADGE OR ID# ; 12788 OR]# WA0171300 TIME POLICE DISPATCHED', 12:23 PM TIME POLICE ARRIVED',12:28 PM
PART I PAGE IT]OF 4❑
REPORT NO. EF01591 CASE# 24-6641 OF COLLISION
06/23/24 12:22
OF CbLLI510N
NARRATIVE
Raymond said he was heading southbound in lane #1 on Rainier Ave N. He mentioned that he
signaled a left turn and cleared his rear mirrors before turning. While crossing over to lane #2,
Danielle's vehicle hit him from the rear of his bike. He noted that he was trying to turn left into the
Renton Municipal Airport on the west side of the property that enters W Perimeter RD. He suffered
injuries on his left leg, hip, and hand. Unknown what type of injuries. He was then transported to
Valley Medical Center for his injuries. I observed his bike and saw no damage, but his chains were off
in their general placements. His bike was given to SALAZAR, SANDRA MARIE. Photos of his bike
were taken and uploaded to evidence. A medical form was filled out and completed.
Officer Onish spoke with Sandra, a bicyclist who saw the incident. He advised that Sandra was
traveling in the same direction and lane as Raymond but was directly behind him. She said Raymond
did have his left signal turn (hand signal), which he conducted, but when he crossed over to lane #2,
Raymond was hit by Danielle's vehicle. It should be noted that before Officer Onish spoke with her,
she told me she was trying to tell Raymond not to turn.
Officer Ridgeway spoke with the female driver, and he advised that Danielle was traveling
southbound in lane #2 on Rainier Ave N. She observed the bicyclist make a left turn signal with his
hand and made a left turn into lane #1, causing him to hit her right rear fender. The vehicle had minor
damage, and she was uninjured. Photos were taken and uploaded to evidence. Also, please see
Officer Ridgeway's sup report for further details regarding his conversation with Danielle.
Officer Ridgeway also spoke with two other witnesses, MARC, a passenger of Danielle, and
SIENGKHAM, the driver behind Danielle. Both witnesses told stories similar to Danielle's; please see
Officer Ridgeway's report for further details.
Photos were taken on the scene and uploaded as evidence.
It Was determined by officers that no foul play occurred in this accident.
PAGE 3 OF 4
REPORT NO.! EF01591 CASE# ' 24-6641 DATE AND TIME 06/23/24 12:22
OF COLLISION
l 2 �ft
a � M�LiYSd3�5�hf`', ..,�w 'zip.�"'� �'. 6SN`11"�._ MUs^C¢'�£R.;�N@blS.SP�:� .if�"�' ky'}�ri4iCk•�„F�..
PAGE 4 OF 4