HomeMy WebLinkAbout23-9332 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-9332 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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 08 - 1-- 2023 1430 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE S BLOCK NO. e✓ 30
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO �/ D:2067258937 0 9 30
6� LAST NAME SANGDER FIRSTNAME LAWRENCE MIDDLE A 1 1 2 31
INITIAL
STREET 01 9646 RENTON AVE S CITY SEATTLE ST WA ZIP 981185720 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATNES# FUZFACE STATE WA VIN# 1GTGK24K8ME502733
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 1991 MAKE GMC MODEL SIERRA STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE J 9 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO LAWRENCESANODER9646RENTONAVES SEATTLE WA98118 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO PEMCO CA 0389698 3 4
IN EFFECT &POLICY# 9TOP
VEwc LEGALLvLE 5 36
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068434446
16 a
LAST NAME CONYERS FIRST NAME DESTINY MIDDLE I S
INITIAL
17❑ STREET ❑', 9551 RAINIER AVE S APT 313 CITY SEATTLE ST WA ZIP 981186050 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES t l NO❑
19 DRIVER'S STATE WA ]SEX IF D.C.B. O6 _ 29 _ 1996 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BVL2446 TATe WA VIN1t 3VWC576U3KM111372
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE VOLK MODEL JETTA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DESTINY CONYERS 9551 RAINIER AVE S APT 313 SEATTLEWA98118 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 4754714 B1047IN 1U
9TOP
VE""LE CITATION# CHARGE o BOTTOMLEGALLYYES NEI25❑ J
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE01706
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9332
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 081423 1 responded to a 2-vehicle non injury/non-blocking collision that occurred on Logan Ave S
(30 block).
I contacted the driver of unit 2 who told me they were slowing on northbound on Logan Ave S to make
a right turn into a private driveway when she was hit from behind by unit 1. Unit 2 sustained rear
bumper and trunk damage.
I contacted the driver of unit 1 who told me he was traveling behind unit 2. He says he didnt realize
she was slowing to turn and ended up running into the back of her vehicle.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 08-14-23 03:45 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 9/23/2023 8:53:07 PM
BADGE OR ID# 10377 ORI#' WA0171300 TIME POLICE DISPATCHED 2:30 PM TIME POLICE ARRIVED 2:40 PM
PART I PAGE IT]OF 3�
REPORT NO.! EE01706 CASE# ' 23-9332 DATE AND TIME 08/14/23 14:30
OF COLLISION
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