HomeMy WebLinkAbout23-8059 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8059 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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# ❑
cowsloN 07 - 1-- 2023 1720 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD ST BLOCK NO. e✓ 1400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2067249870 0 11
30
6� LAST NAME RUDY FIRSTNAME YESSENIA MIDDLE M 1 1 2 31
INITIAL
STREET ❑✓ 3017 S 224TH ST#C CITY DES MOINES ST WA 21p 98148 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ PI ATFBit BTS3725 sTArI WA urN#' JN8AT2MF3KW502212
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE ] $ 34
13 2 2019 NISS ROGUE DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO YESSENIA RUDY302281STAVE S FEDERAL WAYWA 98003 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# STOP
vErIICLE CHARGE 5 36
EGHALLY YES❑NO❑ CITATION# 3AO402364 OP MOT VEH W/OUT INSURANCE o Borrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES NO V D:2063692160
VEHICLE CYCLE : OWNER
16 a
LAST NAME HARRIS FIRST NAME KRISTEN MIDDLE R
INITIAL
17❑ STREET ❑', 22021 196TH AVE SE APT C CITY RENTON ST WA ZIP 980580400 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES
t l NO�
19 LICENSE# STATE WA ]SEX IF M.C... 03 _ 13 _ 1950 El 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I BLR5393 TAre WA vIN1i 2C4RDGCG7HR724427
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE DODG MODEL GRAND STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO KRISTEN HARRIS 10945 SE 168TH ST RENTON WA 98055 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO ECONOMY PREFERRED 0154110541
IN EFFECTVEHICLE ❑ ,.I—I CITATION# CHARGEC�Ql
LEGALLY YES N`E]
25 s � a
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. ED82456
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8059
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 parking lot of a business on the south side of the 1400 blk of SW 43rd ST intending
to turn left into the center turn lane of SW 43rd ST westbound. Unit 2 was traveling eastbound in the
1400 blk of SW 43rd ST just transitioning into the center turn lane to turn left into a parking lot on the
northbound side within 300 ft. Traffic in the eastbound lanes of SW 43rd ST was heavy and backed
up which is why Unit 2 transitioned early and Unit 1 needed to wait for a break and limited visibility.
Drivers on eastbound SW 43rd ST stopped and left space for Unit 1 to make the left turn and were
signaling her to proceed. Unit 1 initiated this left turn based on this prompt not realizing Unit 2 was
approaching lawfully in the center turn lane. As Unit 1 initiated the left turn into the center turn lane, it
pulled into the path of Unit 2 which was approaching eastbound. The front end of Unit 1 struck the
front end of Unit 2 causing minor damage to Unit 2 and moderate damage with airbag deployment to
Unit 1.
Driver 1 advised that Unit 1 was uninsured. Driver 1 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 7/19/2023 2:36:11 PM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED; 5:22 Pry] TIME POLICE ARRIVED 5:26 PM
PART I PAGE IT]OF 3�
REPORT NO. ED8 4 6 CASE# 2y8 5 A m°M\ O»13/23 ]22
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