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Home My WebLink About23-8077 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 23-8077 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 03 STRUCK' WOOD 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 1344 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE CAR RD BLOCK NO. e✓ 10500 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e 105TH PL SE 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2064760563 0 11 30 6� LAST NAME WATKINS FIRSTNAME DEYJANAYE MIDDLE Z 1 1 2 31 INITIAL STREET ❑✓ 12601 68TH AVE S CITY SEATTLE ST WA ZIP, 98178 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑ USE CLASS SEA TBELT BURN LEFT NECK SORE LEFT KNEE 3 10 9❑ Pl ATE 14 CHF7477 STATE WAa VIN#' JT2BG22K4Y0481986 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE#t FROM To TRLR. TRCR 3 5 33 12 3 5 VIN#j VIN#I FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 3 34 13 3 2000 TOYT CAMRY DAMAGE YES NO MEYER YES❑ NO✓ REGISTEREDOWNERINFO py(LLllVENZANT220SW SUNSET BLVD APT F203 RENTON WA 98057 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 ABILI INSURANCE❑ IN CO 3 4 IN EFFECT &POLICY# STOP VEHICLE CHARGE 5 36 LEGALL'Y Yes❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066044502 16 a LAST NAME MELNYK FIRST NAME NATALIYA MIDDLE N INITIAL 17❑ STREET ❑', 27532 44TH PL S CITY AUBURN ST WA ZIP 980012003 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALt—TRANSPORTED ❑ 38 INTERLOCKYES�NO� INTERLOCK YES N0F YEst lNOF,/] 19 LICENSE# STATE WA SEX F M D.C.B. 03 �_ 20 _ 2002 0 39 HELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE 2 CLASS ❑ 21❑ LICENSE I CDN5876 TATE WA VIN# WVWD67AJ1AW406525 ❑ 41 PLATE# 42 22❑ PLATILER E# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. I VEH YEAR 2010 MAKE VOLK MODEL GOLF STYLE VEHI DAMAGE TO TOWED B Gov H 44 Yr ✓WED NOO BLIN GENE MEYER V YES No 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO STOP 5 Le L..LLY YES❑ N,J�J CITATION# CHARGE io BOTTOM LEGA 25 BADJ 6 OFFICER'S NAME(PRINT) OFFICER PHONE GE OR ID# AGENCY 26 C.STEED 8770 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED79649 COLLISION REPORT III III III III III 111 1591972 CASE# 23-8077 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) JOHNSON RAYANA M (LAST FIRST, ADDRESS&PHONE# 4214 242ND AVE SE SAMMAMISH WA 98029 6304505709 SEXi F MMODYyry 07 - O6 - 1981 PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ ❑✓ POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) BURNETTE BRAN D ADDRESS&PHONE# D O B 12811 SE 161ST RENTON WA 98058 4254439408 SEX M MMoovvvv 12 - 11 - 1966 PASSENGER ❑ POS. USE CLASS WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' On 07/14/23 at about 1347 hrs I arrived at an injury collision on SE Carr Rd at 105th PL SE, in the City of Renton, County of King, and State of Washington. Two witnesses flagged me down and described the collision the same. Unit#1 was coming from WB SE Carr Rd making a SB turn on to 105th PL SE. The first lane of EB traffic had stopped and the driver of Unit#1 attempted to make the left turn. Unit#2 was traveling EB on SE Carr Rd in the outside lane approaching 105th PL SE. Unit #1 turned in front of Unit#2 causing the collision. The driver of Unit#2 said she did not see Unit#1 in time to brake and she estimated she was traveling at 30-35 mph. Unit#2 was pushed off the roadway from the collision and into the 76 Gas Station Sign at 10545 SE Carr Rd causing significant damage to the sign. Driver#1 complained of a seatbelt burn on the left side of her neck and left knee pain. Driver#2 advised she was uninjured. Neither driver had insurance for their vehicles. Both vehicles were undrivable and impounded by Gene Meyer Towing. The 76 Gas Station attendant was also given an exchange of information for the property damage. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically Signed by Officer Steed on 07/14/23 1457 hrs, Renton Washington Cassidy Steed/8770 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.STEED 07-14-23 02:55 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 7/14/2023 3:50:11 PM BADGE OR ID# 8770 OR]# WA0171300 TIME POLICE DISPATCHED 1:47 Pry TIME POLICE ARRIVED 1:47 PM FART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. ED79649 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-8077 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:2534318422 29 FIRST NAME MIDDLE LAST NAME CHANCE YOUNG INITIAL STREET 30 NEW AnDRFSP' 10545 SE CARR RD CITY RENTON ST WA ZIP 98058 6 II 1 31 CDL GNITItN REQUIRED GNITION PRESENT MEDEC INTERLOCK YEsNo zERLOCK YES❑N0� T L DRIVER'S STATE I SEX M M�DDYBYv 07 - 08 - 1971 LICENSE 7F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE cLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NEn+AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiREE7 IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.STEED 07-14-23 02:55 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 � OR BADGE 8770 O#I',WA0171300 APPROVED BY 7/114/2023 PAGE�OF 4 3000-345-013(R 11118) REPORT NO. ED79649 CASE# ' 23-8077 DATE AND TIME 07/14/23 13:44 OF COLLISION s Price Sign I PAGE 4 OF 4