HomeMy WebLinkAbout23-9816 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED94573 170
27
COLLISION REP FIT 1591971
CASE 23-9816 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT 8 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 1909 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD ST BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET MILES e S ❑ W e E VALLEY RD
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259195194 0 11
30
6� LAST NAME LEE FIRSTNAME CATHERINE MIDDLE E 1 2 31
INITIAL
STREET ❑, 10933 SE 186TH ST CITY RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
CENSE STATE WA SEX'F MIDIAY' 05 — 01 — 2007 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATNES# APH2O51 sTAr WAV N# JTEBU14R078091757
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRU2 3 7 33
12 3 5 VIN# uIN#'
FROM TO
VEH.YEAR 2007 MAKE TOYT MODEL 4 STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 DAMAGE YES YES❑ NO✓
REGISTERED OWNER INFO CHERYL PARKS 10933 SE 186TH ST RENTONWA 98055 D:2069548734 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO CALIFORNIA CASUALTY 1013831486 2 3 4
IN EFFECT &POLICY# 9TOP
ve'C 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066188417
16 a
LAST NAME WEAVER FIRST NAME PASHA MIDDLE N
INITIAL
17 STREET I❑ 600 SW 5TH CT,APT F301 CITY RENTON ST WA ZIP 98057 37
NEW ADOREss❑'
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 DRIVER'S STATE WA ]SEX IF D.C.B. 12 _ 20 _ 1974 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAU EY 1 NATURE OF INJURIES 40
❑LICENSE I 21❑ PLA E# BXV0415 TArE WA VIN# 1(BIZDSST6NF185118 41
1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2022 MAKE CHEV MODEL MALIBU STYLE qD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO EAN HOLDINGS LLC 507 E SUMMA ST CENTRALIA WA 98531 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU8 PORGY#E CO NATIONAL GENERAL 2016789560 I STOP 5
IN EFFECT
VEHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGALLY YES N`LJ
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JASON JONES 11635 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED94573
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9816
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PARKS CHERYL L
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
10933 SE 186TH ST RENTON WA 98055 2069548734 SEXi F MMDDYyry 05 - 19 - 1970
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑' 1 POS. 3 2 4 1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O E4
SEXI MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 8-25-23, at about 1915 hours, I was dispatched to a collision that occurred in the 400 block of SW
43rd.
Upon I arrival, I saw Unit 1 which had damage the driver's side door area and Unit 2 which had
damage to the front driver side.
I contacted the driver and passenger of Unit 1. They both claimed not to be injured. Both stated they
were traveling west on SW 43rd ST, were attempting to merge into a left turn lane, and was struck by
Unit 2.
1 contacted the driver of Unit 2. The driver of Unit 2 claimed not to be injured. The driver of Unit 2
stated she was traveling west on SW 43rd ST in a left turn and was struck by Unit 1 when it entered
her lane.
Based on the evidence at the scene and the statements made to me, 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 08-25-23 09:32 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 8/31/2023 3:00:27 PM
BADGE OR ID# 11635 ORI#' WA0171300 TIME POLICE DISPATCHED 7:15 PM TIME POLICE ARRIVED',7:20 PM
PART Ei PAGE 2�OF❑
REPORT NO. ED94573 CASE# ' 23-9816 DATE AND TIME 08/25/23 19:09
OF COLLISION
v
NOT TO SCALE
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SV+I 43rd:ST
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