HomeMy WebLinkAbout23-8057 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8057 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT 8 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 07 - 1-- 2023 1658 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e MAPLE AVE SW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2068597444 0 11
30
6� LAST NAME MESSENGER FIRSTNAME ISAIAH MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 4750 AUBURN WAY N APT F403 CITY AUBURN ST WA 2jp, 980022021 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]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
LICENSE CGK8679 sTArI WAVIN# JTHBD182110005684
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 5 33
12 3 5 VIN#' VIN#I
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 7 3 34
13 2001 LEXS IS DAMAGE YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO ISAIAH MESSENGER4750 AUBURN WAYNAPTF403 AUBURN WA 98002 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
EGALLY YES No CITATION# 3AO402363 OP MOT VEH W/OUT INSURANCE o eorroM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY ❑ 1/DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER
YES NO D:4256147857
16 a
LASTNAME ASKEW FIRST NAME JOSEPH MIDDLE D
INITIAL
17❑ STREET �', 13215 NE 123RD ST APT D117 CITY KIRKLAND ST WA ZIP 98034 37
NEW ADDRESS ❑
18E CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED ❑ 38
INTERLOCKYES — NOR INTERLOCK YEs I I NoF YES t l NOF,—/]
19 D IVE
USE ET NJAURSY [NATURE OF INJURIES LEFT HAND COMPLAINT OF PAIN ❑ 40
20❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 2 7
21❑ LICENSE BCK5030 TAre I WA VIN# 1FADP3E21GL388184
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2016 MAKE FORD MODEL FOCUS STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO JILL LENHART 13215 NE 123RD STAPT D117 KIRKLAND WA 98034 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO GEIC04589580861IN
VEHICLe ❑ C[ CITATION# CHARGE C�Ql
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED82460
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8057
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 in the center turn lane facing west on SW Grady Way intending to turn left onto
southbound Maple AVE SW. Unit 2 was traveling eastbound in on SW Grady Way approaching
Maple AVE SW in the right outside lane of three eastbound lanes. The inside and middle eastbound
lanes of traffic were backed up with stopped traffic waiting for a traffic light but the lane in which Unit 2
was traveling in (outside right lane) was moving as it was to be a right turn only lane. Driver 1 states
he was waiting for a break in the traffic to make the left southbound turn across the three eastbound
lanes of SW Grady Way. He states drivers in these middle and inside lanes stopped enough to leave
space for the left turn and were motioning him to make the turn. Driver 1 states he was hesitant but
the drivers were waiving intently. Unit initiated the left southbound turn not realizing Unit 2 was
approaching and pulled into the path of Unit 2 which was traveling with the right of way. The front
end of Unit 2 impacted the front passenger side of Unit 1 causing moderate/heavy and disabling
damage to both vehicles.
Driver 1 advised that Unit 1 was uninsured. Driver 1 was 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 07-17-23 10:16 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/24/2023 11:27:00 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 4:89 Pry TIME POLICE ARRIVED',5:04 PM
PART I PAGE IT]OF 3�
REPORT NO. ED82460 CASE# ' 23-8057 DATE AND TIME 07/13/23 16:58
OF COLLISION
i
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***NOT TO SCALE***
MAPLE AVE SW Gi
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4
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