HomeMy WebLinkAbout23-7135 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7135 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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# ❑
cawsloN 06 - 1-- 2023 1752 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD N BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:6024002837 0 11
30
6� LAST NAME NELSON FIRSTNAME DARRELL MIDDLE A 1 1 2 31
INITIAL
STREET ❑✓ 7311 COAL CREEK PKWY K103 CITY NEWCASTLE ST WA ZIP 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 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 aT�S� BOZ3217 sTArI WAVIN# JTJHW31 U160041862
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR N MAKE LEXS MODEL RX STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES 1 $ 34
13 2 YES❑ NO
REGISTERED OWNER INFO DARRELL NELSON 14529 C ST S APT 24 TACOMA WA 98444 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# � 9TOP 5
VE"'CLE CHARGE 10 BOTTOM 36
LEGALLY YES❑NO❑ CITATION# 3AO492510,3AO492510 FLD SIGNAL STOPS/TURNS-UNSAFE
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064669447
16 a
LAST NAME DORSEY FIRST NAME CHAD MIDDLE R
INITIAL
17❑ STREET ❑', 26708 SE RAVENSDALE WAY CITY RAVENSDALE ST WA ZIP 980519677 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK yEEsIII I I NOF YEs t l NOF,/
19 DRIVER #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE BUY3185 TAre WA VIN# 1FMDU34X2SUC25588
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
GI
VEH YEAR 1995 MAKE FORD MODEL EXPLORE STYLE DAMAGE TO TOWED BY OV H 44
IVEHI NO BLIN WED✓ O GENE MEYER YES Noy/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#E CO pROGRESSIVE 959835857
IN ®TOP
VEHICLE ❑ C—I CITATION# CHARGE io BOTTOM
LEGALLY YES N
25 a
7KLANE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED74271
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7135
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 Sunset BLVD N approaching the merge with the Houser Way
Bypass in the 400 blk of Sunset BLVD N. Unit 2 was traveling southbound on the Houser Way
Bypass about to merge with Sunset BLVD N in the 400 blk of Sunset BLVD N. Houser Way Bypass
is a two-lane tunnel that comes up from a lower elevation up to Sunset BLVD N. Sunset BLVD N,
where Unit 1 had been traveling, is two lanes with Unit 1 in the left lane. When the merge occurs, a
third lane is added from the lane from the Houser Way Bypass making the left lane Unit 1 was
traveling in turn into the middle lane of 3 southbound lanes on Sunset BLVD N. Unit 2 was traveling
in the now left lane of southbound Sunset BLVD N. Unit 1 intended to turn left into a parking lot on
the east side of Sunset BLVD N and stated was unaware a lane was added to the left (east) of Unit 1.
When Unit 1 initiated this left turn, the front driver's side of Unit 1 impacted the rear passenger side of
Unit 2. This impact spun Unit 2 clockwise eventually causing it to roll over onto its roof and come to
rest. Unit 1 sustained moderate damage to the front driver's side while Unit 2 sustained heavy
damage on the top of the vehicle as a result of the rollover. No injuries reported but Renton AID
responded to evaluate both drivers. Driver 1 advised he did not have insurance.
Driver 1 was cited for unsafe lane change by changing lanes without ensuring this could be done
safely, changing lanes into the lane occupied by Unit 2, which was the proximate cause of the
collision. Driver 1 also cited for operating a motor vehicle without insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 06-24-23 01:33 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/27/2023 2:10:39 PM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED; 5:54 PM TIME POLICE ARRIVED 5:56 PM
PART I PAGE IT]OF 3�
REPORT NO. ED74271 CASE# 23-7135 DATE AND TIME 06/23/2317:52
OF COLLISION
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