HomeMy WebLinkAbout23-8478 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8478 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 2 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 1016 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD N BLOCK NO. e✓ 200
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:4255635826 0 11
30
6� LAST NAME SCOTT FIRSTNAME ANTHONY MIDDLE W 1 2 31
INITIAL
STREET ❑ 12305 TIETON DR CITY YAKIMA ST WA ZIP 989088085 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� C21470Y sTATI WAurN# 1C6RR7GTOES128151
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 3 0 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2014 RAM 1500 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ANTHONY SCOTT 12305 TIETON DR YAKIMA WA 98908 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO eq�T3 4
IN EFFECT &POLICY# 9TOP
VEH CHARGE o eorrom 5 36
LEGALLY YEs No CITATION# 3A0492515 OP MOT VEH W/OUT INSURANCE
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2066650334
16 a
LAST NAME COBB FIRST NAME JANESSA MIDDLE M
INITIAL
17❑ STREET �', 600 SW 5TH CT H2O2 CITY RENTON ST WA Zip 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YEs t l NoF,/
19[ DRIVER'S STATE WA ]SEX IF D.C.B. 05 _ 01 1997 El 39
LICENSE# MMDDYY
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE 2 CLASS COMPLAINT ARM PAIN ❑
21❑ LICENSE BUC5475 TATe I WA VIN# 3VWLL7AJ4BM075379
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
GI
VEH YEAR 2011 MAKE VOLK MODEL,/ETTA STYLE $D DAMAGE TO ✓WED NO BANKERS YES NoO BLIN TOWED BY 44
OV H
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO ESURANCEPAWA9316607IN CQl
VEHICLE ❑ C—I CITATION# CHARGE io
LEGALLY YES N`LJ
25 s 7 6
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. ED85543
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8478
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 on northbound Sunset BLVD N intending to turn left into the parking lot of 219 Sunset
BLVD N across 4 lanes of southbound traffic. Unit 2 was traveling southbound in the 200 blk of
Sunset BLVD N in the far right of the 4 southbound lanes. The left three lanes of southbound Sunset
BLVD N were backed up with traffic from a traffic light but several other motorist left a break to let Unit
1 make the left turn. At this prompting, Unit 1 initiated the left hand turn across the three stopped
lanes of southbound traffic not realizing Unit 2 was approaching southbound with a free lane on the
far right and had the right of way. Unit 1 pulled into the path of Unit 2, which was the proximate cause
of the collision, and the front end of Unit 2 impacted the front passenger side of Unit 1. Unit 1
sustained moderate/heavy disabling damage as did Unit 2. Unit 2 towed by Bankers tow. Driver 1
advised Unit 1 was uninsured.
Driver 1 was cited for operating a motor vehicle without liability 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 07-25-23 09:07 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/2/2023 1:04:12 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 10:17 AM TIME POLICE ARRIVED 10:19 AM
PART I PAGE IT]OF
REPORT NO. ED85543 CASE# ' 23-8478 DATE AND TIME 07/24/23 10:16
OF COLLISION
NJ
C>
O
W
ED
PARKING LOT
219 SUNSET BLVD N
ON
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