HomeMy WebLinkAbout23-9305 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-9305 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK' BUILDING
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 08 - 1-- 2023 2233 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD M4033
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4255727717 30
6� LAST NAME WILLIAMS FIRSTNAME MICHAEL MIDDLE E 1 11
31
INITIAL
STREET ❑✓ 15753 SE RENTON ISSAQUAH RD CITY RENTON ST WA Zjp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 1 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C78605W sTArr WAVIN# 1FTCR10A8TUC59494
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12❑ VIN#' VIN#
1996 FORD RANGE pl( OIIF FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED If TO BLIN TOWED BY GOVT.VEHICLE
13 A DAMAGE YES NO �/ YES[:] NO
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ UABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# STOP
VEHICLE CHARGE 5 36
LEcnLLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY ,/ DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2063996302
16❑
LAST NAME ASSOCIATES FIRST NAME DALPAY MIDDLE
INITIAL
17 STREET I SUNSET BLVD CITY' RENTON ST WA ZIP 98059 37
ADDREs�' 4033 NE
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19 LLIICENS # STATE SEX X MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PIR I I TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I STOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED90217
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9305
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CHONG JUNE
(LAST FIRST,
ADDRESS&PHONE#
7509 LAKEWOOD DR W APT D7 LAKEWOOD WA 98499 2535188268 SEX M MMDDYyry 11 - O6 - 2000
PASSENGER WITNESS SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ a[UNIT# POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYVYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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 08/13/2023 at 2235 hours I was dispatched to a collision at 4033 NE Sunset Blvd in the City of
Renton, King County, Washington. The collision involved Vehicle 1 and Building 2 which was closed
at the time of the collision. I spoke with the owner of Vehicle 1 who stated that he had parked Vehicle
1 in a parking spot in front of the business. Vehicle 1's owner explained that when he exited the
vehicle, the vehicle began moving forward without anyone else inside of the vehicle. Vehicle 1's
owner stated that Vehicle 1 collided with Building 2 causing damage to the front door of the building. I
spoke with 2 witnesses at the scene who both stated that Vehicle 1's owner was outside of the
vehicle when the collision occurred. It appears that there may have been a mechanical failure inside
of Vehicle 1 or that Vehicle 1's owner did not place Vehicle 1 in park prior to exiting the vehicle.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 08-13-23 11:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 811712023 3:27:18 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 10:35 PM TIME POLICE ARRIVED';10:40 PM
PART I PAGE 2�OF❑
REPORT NO. ED90217 CASE# 23-9305 DATE AND TIME 08/13/23 22:33
OF COLLISION
***NOT TO SIDLE***
4033 NE;SUNSET BLVa
PAGE 3 OF 3