HomeMy WebLinkAbout23-9972 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9972 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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#
COLLISION.. 08 - 1-- 2023 1948 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e 1405 NORTH ON RAMP
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:3603914172 0 11
30
6❑ LAST NAME SYBRANDY FIRSTNAME ISAAC MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 20703 DIKE RD CITY MOUNT VERNON ST WA ZIP 98273 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
DRIVER # STATE WA SEX'M MI MIT Y
$ L 04 - 24 - 2003 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET U E 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ P1 AT 14 B05653U STATE WA VIN# 2FTRF17W34CA21039
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 $ 34
13 1 2004 FORD F150 I'K DAMAGE YES NO �LIkRS vEs❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE U INSURANCE CO OREGON MUTUAL INS GROUP 54.01384 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YEs No CITATION# 3AO576457 FAIL YIELD LEFT TURN MOTOR o Borrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2537090382
16 a
LAST NAME WILLIAMSON FIRST NAME GARY MIDDLE ,/
INITIAL
17 STREET NEW ADOREsS❑' 2009 HARRINGTON AVE NE CITY RENTON ST WA ZIP 98056 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK vEs It I NOF YES
t l NOF,/
19 LDI IVER # STATE WA SEX M M .C... 09 _ 21 1965 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CHP9457 TATE WA VIN# 41
JN8AROSY5VW168475 1
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
Gov HI
VEH YEAR 1997 MAKE jyI$$ MODEL pgTHFIN STYLE UT VEHICLE DAMAGE TOWED✓ NOO BLIN TOWED By 44
YESBANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
VEHICLE YES❑ Nu CITATION# 3AO576458 CHARGE OP MOT VEH W/OUT INSURANCE ,o BOTTOM
GALLY
25 ' a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26GROZAV 12489 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED94575
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9972
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
PM 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
BRYAN GROZAV 08-29-23 10:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 8/31/2023 3:00:21 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED 7:50 PM TIME POLICE ARRIVED]7:55 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED94575 CASE# 23-9972 OF COLLISION
08/29/23 19:48
OF CbLLI510N
NARRATIVE
CASE 23-9972
SECTOR CITE 3AO576457/576458
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events.
On Tuesday August 29th, 2023, at approximately 19:51, 1 responded to a 911 call regarding a two-
vehicle collision at Sunset Blvd Ne and the north bound 1405 on ramp within the City limits of Renton,
King County, Washington.
'CALL REMARKS: 2 VEH MVA, LINK IF INJ'S - WHI VEH VS. UNK 2ND VEH.
-UNIT ONE: WHITE 2004 FORD F150 WASHINGTON LICENSE: B05653U
-UNIT ONE DRIVER: ISAAC T. SYBRANDY (DOB: 4.24.2003)
-UNIT TWO: BURGUNDY 1997 NISSAN PATHFINDER WASHINGTON LICENSE: CHP9457
-UNIT TWO DRIVER: GARY J. WILLIAMSON (DOB: 9.21.1965)
1 arrived on scene and confirmed there were no injuries, both parties indicated they were fine and did
not need any medical attention. Isaac indicated he was attempting to enter the north 1405 on ramp
and did not see unit two driving south on Sunset Blvd Ne. Gary reported the same thing, said Isaac
turned in front of him and couldn't stop.
Both vehicles needed to be towed since they were not drivable.
Based on the circumstances it was determined Isaac violated RCW 46.61.185.1 FAIL YIELD LEFT
TURN MOTOR VEHICLE (SECTOR CITE 3A0576457). Isaac failed to yield and grant right away to
unit two causing the crash. I informed Isaac he would receive the infraction in the mail.
Gary indicated he recently purchased the vehicle and got it running so he did not have insurance.
Gary was in violation of RCW 46.30.020 OP MOT VEH W/OUT INSURANCE (SECTOR CITE
3A0576458). 1 informed Gary he would receive the infraction in the mail.
I provided Isaac and Gary a copy of the SECTOR exchange of information form.
This concludes my involvement in this case.
I certify/declare under penalty of perjury under the laws of the State of Washington that the foregoing
is true and correct.
Electronically signed by B. Grozav #12489 on 8.29.2023 at 22:45 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED94575 CASE# ' 23-9972 DATE AND TIME 08/29/23 19:48
OF COLLISION
N
i
i
NOT TO SCAB.
1405 NORTH ON RAMP s
i
..........
SUNSET BLVD NE
PAGE 4 OF 4