HomeMy WebLinkAbout23-9998 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED97757 170
27
COLLISION REP FIT 1591971
CASE 23-9998 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4300 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 08 - 1-- 2023 1300 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ 500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e LIND AVE SW
0 4 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓NOESHOLD MET PHONE 0 11
30
6� LAST NAME MANS FIRSTNAME SHERRE MIDDLE R 1 1 2 31
INITIAL
STREET ❑✓ 14081 58TH AVE S B1 CITY TUKWILA ST WA ZIP 98168 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8 LRIIVER # STATE MO SEX'F MI 08 1- 21 - 1992 1 2 32
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET INJCLASSY 1 NATURE OF INJURIES z❑
3
10[1 P1 ATE 14 234NCF sTATe OR V N# 2G1 WD58C769184872
TRAILER STATE TRAILER STATE
11 3 51 PLATE# PLATE# FROM TO
TRLR 3 5. TRLR 33
12 3 5 VIN#' UIN#
FROM TO
VEH.YEAR 2006 MAKE CHEV MODEL IMPALA STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO SHERRE MANS1408118THAVESSITUKWILAWA98168 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# STOP
36
veH'CLe CHARGE 5
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
❑ ""
15 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4259193510
16 1
LAST NAME TAM FIRST NAME WING MIDDLE I C
INITIAL
17❑ STREET ❑', 17532 150TH CT SE UNIT M6 CITY' RENTON ST WA ZIP 980588847 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19[—] LDI IVEW # STATE WA SEX M M D.O.B. 10 _ 18 _ 1950 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BKJ2930 TATE WA VIN# JTDKBRFU4J3596389
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2018 MAKE TOYT MODEL PRIUS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO WING TAM 1806 MAPLELNAPTC13 KENTWA98030 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO SAFECO INS H2348370IN STOP 5
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL io BOTTOM
0(
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97757
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9998
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 083023 1 responded to a 2-vehicle non-injury/blocking collision at SW Grady and Lind Ave SW.
I contacted the driver of unit 2 who told me they were traveling westbound SW Grady in the #1 lane.
Driver says when he entered the intersection at Lind Ave SW on a solid green light, he was involved
in a collision with unit 1. The driver was not injured. The driver's vehicle sustained heavy front-end
damage but remained drivable.
I contacted the driver of unit 1 who told me they were making a left turn from eastbound SW Grady
Way to northbound Lind Ave SW, she was involved in a collision with unit 2. The driver was not
injured. The vehicle sustained rear to mid passenger side damage. Gene Meyers towing for unit 1.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 09-01-23 09:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 911112023 10:19:50 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED; 4:00 PM TIME POLICE ARRIVED 1 1:10 PM
PART I PAGE IT]OF 3�
REPORT NO. ED97757 CASE# ' 23-9998 DATE AND TIME 08/30/23 13:00
OF COLLISION
Lind Ave. SW N
a.y
SW Grad Way
Y �
� FT• . fir=,
t t R Yte.
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