HomeMy WebLinkAbout23-8702 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-8702 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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#
cawsloN 07 - 1-- 2023 1954 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 4300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e WHITMAN CT NE
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2069001908 0 7 30
6� LAST NAME KATSANES FIRSTNAME TAYLOR MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 13027163RD AVE SE CITY RENTON ST WA ZIP 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 9 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATFBit CGP2145 sTArI WA VIN#' JM3KFBDL1H0153819
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2017 MAZD CX-5 SV DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EF IT INSURANCE GEICO 6115869296
IN EFFECT &POLICY# 9TOP
Ela.e CHARGE 10BOTTOM 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:2064921640
16 a
LAST NAME STRIEBY FIRST NAME DUSTIN MIDDLE I M
INITIAL
17❑ STREET NEW ADDREss❑' 2020 GRANT AVE S APT J103 CITY RENTON ST WA ZIP 98055 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX M M D.C.B. 03 _ 02 _ 1991 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CDT8317 TArE 41
WA VIN# JF2SJADC2GH414619 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
GI
VEH YEAR 2016 MAKE $(JB�Q MODEL FORESTE STYLE $V DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO GEIC04347467993IN Q
i o
LEGALLY YES Nu
25❑ I I C
s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84497
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8702
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 07/30/2023 at 2000 hours I was dispatched to a 2 vehicle collision at the intersection of NE 4th St
and Whitman Ct NE. When I arrived, I met with Driver 1 and Driver 2 near their vehicles that were
inoperable and blocking the Eastbound lefthand turn lane. Driver 1 stated that he was traveling West
on NE 4th St in the number 2 lane when he entered the intersection. Driver 1 stated that the sun was
in his eyes at the time of the collision and failed to maintain his lane while crossing through the
intersection of NE 4th St and Whitman Ct NE. Driver 1 stated that the front bumper of Vehicle 1
collided with the front end of Vehicle 2 that was facing East in the lefthand turn lane on NE 4th St.
Driver 2 stated that he was at a complete stop and waiting for traffic to pass so he could make a
lefthand turn from the turn lane while facing East on NE 4th St. Driver 1 stated that he looked up and
saw Vehicle 1 as it merged over into the turn lane. Driver 2 stated that front bumper of Vehicle 1
collided with the front bumper of Vehicle 2. There was airbag deployment during this collision and
Renton Regional Fire Authority (RFA) cleared both involved at the scene. Both Driver 1 and 2 where
the sole occupants of their vehicles at the time of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 07-30-23 08:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 713112023 12:26:18 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 8:00 Pry TIME POLICE ARRIVED',8:03 PM
PART I PAGE IT]OF 3�
REPORT NO. ED84497 CASE# ' 23-8702 DATE AND TIME 07/30/23 19:54
OF COLLISION
QT TO SCALE-
NE 4TH ST
HITAN C
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