HomeMy WebLinkAbout23-7002 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-7002 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 5 3 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# ❑
COLLISION 06 — 1—— 2023 1034 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N BLOCK NO. e✓ 1500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e FACTORYAVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067554669 0 11
30
6� LAST NAME DEMERS FIRSTNAME MARGARET MIDDLE G 1 2 31
INITIAL
STREET ❑ 18921 109TH AVE SE CITY RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'M I D-MMDDVY' 12 — 22 — 1943 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 CLASS I NATURE OF INJURIES z❑
3
10❑ P1 ATNES# BLT9947 sTAr WAV N# 2T18URHE3HC946483
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM ro
TRLR. TRLR 5 1 33
12 3 0 VIN#' VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[AWk GOVT.VEHICLE 34
13 4 2017 TOYT COROL SD DAMAG 3 7 E YES NO YYES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 4
14 LIABILITY INSURANCE ALLSTATE 807550681
IN EFFECT &POLICY# 9TOP
Ela.e CHARGE to BOTTOM 5 36
LvECALHLv res❑NO❑ CITATION# 5
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:5202497150
16 a
LAST NAME CUSTER FIRST NAME AUDREY MIDDLE A
INITIAL
17 STREET❑ NEW ADDREsS❑' 3340 DEL SOL BLVD 231 CITY SAN DIEGO ST CA Zip 92154 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YEs❑NOF,/
19 DRIVER'S STATE CA ]SEX IF I D.C.B. 12 _ 30 _ 1957 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# 6UCE277 TArE CA VIN# 4S4BRBKC4A3382160 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2010 MAKE S(JB�Q MODEL D(17'B/�C STYLE UT —TEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 0081313 OOC 71019IN 9TOP 5
--E ❑ ,J� CITATION# CHARGE
25 to BOTTOM
LEGALLY YES N`L J
' e
7JAINEBER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
12532 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73325
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7002
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 06/20/2023, at approximately 1036 hours I was dispatched to Bronson Way N and Houser Way N
for a report of a blocking collision. I arrived on scene and spoke with Driver 1 who stated she was
northbound on Houser Way N. Driver 1 stated the light turned green and she proceeded through into
intersection, then the light quickly turned red. Driver 1 stated she was then struck on the passenger
side by Driver 2. Driver 2 stated she was westbound on Bronson Way N when her light turned green.
She proceeded into the intersection, and she stated all of a sudden, she saw Driver 1 in front of her
and she did not have time to stop. Vehicles 1 and 2 were towed by Bankers. There were no injuries to
either party. Both parties with provided with information exchanges.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JACOB WEBER 06-20-23 04:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 6/24/2023 1:09:38 PM
BADGE OR ID# 12532 ORI#' i WA0171300 TIME POLICE DISPATCHED 10:36 AM TIME POLICE ARRIVED]10:44 AM
PART Ei PAGE IT]OF
REPORT NO. ED73325 CASE# ' 23-7002 DATE AND TIME 06/20/23 10:34
OF COLLISION
e&
'i
Bronson Way N
Houser Way N
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