HomeMy WebLinkAbout23-9646 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-9646 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 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# ❑
cowsloN 08 - 1-- 2023 1947 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 7TH ST BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 2000 FMILES N EET e S ❑ E e HARDIEAVESW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257651030 0 11
30
6� LAST NAME WOELKE FIRSTNAME RICHARD MIDDLE W 1 1 2 31
INITIAL
STREET ❑, 10518 UPPER PRESTON RD SE CITY I ISSAQUAH ST I WA ZIP, z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� AJW4441 sTATI WAurN# 1N46U31D4RC108638
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. YRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 34
13 4 1994 NISS ALTIMA 4D DAMAG 7 3 E YES NO YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 6137502313 4
IN EFFECT &POLICY# TOPVE"'CLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:5092008119
16 a
LAST NAME BAUTISTA FIRST NAME JENNIFER MIDDLE
INITIAL
17❑ STREET NEW ADDREss❑' 4147 DELRIDGE WAY SW CITY SEATTLE ST WA ZIP 98106 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 03 _ 15 _ 1997 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES 40
USE CLASS LEG AND HAND PAIN
❑ILICENSE 21❑ PLA E# ALP8785 TATE 41
WA VIN# 1J4GK48K64W285922 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BY Gov HI 44
VEH YEAR 2004 MAKE JEEP MODEL LIBERTY STYLE UT -7EHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 6134180527IN 9TOP 5
VEHICLE YES[:] N
C[:] CITATION# CHARGE io BOTTOM
LEGALLY
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JASON JONES 11635 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED92883
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9646
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JIMENEZ MARIA
(LAST FIRST,
ADDRESS&PHONE# D O.B.
UNKNOWN RENTON WA 98057 4253218207 SEX U MMDDYyYv - -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET CLASS NATURE OF INJURIES
❑ ❑✓ , POS. USE CLASS :
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
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 8-21-23, at about 1949 hours, I was dispatched to a collision that occurred in the 200 block of SW
7th ST.
Upon I arrival I observed both Unit 1 and Unit 2 with major front-end damage and both required a tow.
I contacted the driver of Unit 1 and he stated he was not injured nor did he need medical attention. He
relayed the following: He was not paying attention attempted to make a left turn in about the 200
block of SW 7th ST and struck Unit 2.
The driver of Unit 2 was contacted and evaluated by the fire department for leg and hand pain, but
was not transported to the hospital. It was relayed to me that the driver of Unit 2 was traveling east on
SW 7th when Unit 1 entered their lane of travel and struck Unit 2, confirming Unit 1's account of the
incident.
I gave the driver of Unit 1 a verbal warning for inattention.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON JONES 08-21-23 08:47 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 8/25/2023 7:52:53 PM
BADGE OR ID# ! 11635 ORI#; WA0171300 TIME POLICE DISPATCHED 7:49 PM TIME POLICE ARRIVED]7:54 PM
PART I PAGE IT]OF 3�
REPORT NO. ED92883 CASE# ' 23-9646 DATE AND TIME 08/21/23 19:47
OF COLLISION
NOT TO SCALE
SW 7TH S (200 BLOCK)
2 ,
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