HomeMy WebLinkAbout23-10070 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-10070 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4'IDO 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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# ❑
OOwsION 08 - 1-- 2023 1446 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RENTON CENTER WAY SW BLOCK T e✓
MILEPOST 365
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2062580878 30
6� LAST NAME CROFTON FIRSTNAME KATHLEEN MIDDLE C 1 2 31
INITIAL
STREET ❑ 18315 17TH ST E CITY LAKE TAPPS ST WA 2jp 98391 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ 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❑ Pi aT�S� BNJ8309 sTAr1 WAvIN# 3N1AB7AP7HL636807
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12❑ vIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13❑2 2017 NISS SENTRA SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 5168456-F13.47 3 4
IN EFFECT &POLICY# 9TOP
15❑ vewCLE 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4253061794
16 2
LAST NAME WOODIE FIRST NAME DONALD MIDDLE L
INITIAL
17 1-1STREET
CITY ST' ZIP 37
NEW ADDRES7
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVE #
ON DUTY STATUS 3 AIRBAG RESTR EJECT , HELMET I INJURY 6 NATURE OF INJURIES 40
USE CLASS SWOLLEN THUMB
❑21❑ TArE 41
LICENSE VIN# 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 Q 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PART A PAGE 01 OF
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED95740
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10070
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HAZARD AARON D
(LAST FIRST,
ADDRESS&PHONE#
6928 S RUSTIC RD SEATTlE WA 98178 2068561131 SEX M MMDOYyry 10 - 08 - 1945
PASSENGER SEAT AIRBAG RESTR. EJECT ' HELIVIET INJURY NATURE OF INJURIES
❑ �'WITNESS UNIT# 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.Q.B.MMDD -❑
YYYY.
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.
STEVEN FAJARILLO 09-04-23 05:57 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 9/4/2023 6:55:04 PM
BADGE OR ID# 12847 ORI# WA0171300 TIME POLICE DISPATCHED Y:47 Pry] TIME POLICE ARRIVED',2:51 PM
PART Ei PAGE IT]OF 4]
TIME
REPORT NO. ED95740 CASE# 23-10070 OF COLLISION08/31/23 14:46
NARRATIVE
23-10070
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. Statements have been paraphrased and
summarized.
On 08-31-2023 1 was working as a police officer in the city of Renton. At approximately 1447 hours I
was dispatched to the report of an accident with injuries at Fred Meyer, 365 Renton Center Way SW,
City of Renton, County of King, WA. This incident was captured on my department issued Axon body
camera.
According to the notes in the call, a vehicle collided with a pedestrian in the parking lot of the location.
I arrived on scene and found the pedestrian to be awake, alert, and talking. He verbally identified
himself as Donald L Woodie (DOB: 01-17-1958). Donald had a swollen left thumb and was in mild
pain. Renton Fire arrived and cleared him medically. I photographed his thumb and later placed it on
Evidence.com. Donald was crossing the street and said a vehicle (Vehicle 1) took a left turn and did
not stop. Donald walked faster to avoid being hit, but the vehicle's front left quarter panel hit his left
hand.
I contacted Vehicle 1, a silver 2017 Nissan Sentra (WA/BNJ8309). The driver and lone occupant of
the vehicle was Kathleen C Crofton (DOB:06-15-1990). Kathleen said she was taking a left hand turn
in the parking lot and did not see Donald. Before she could slow down, she collided with him.
Kathleen admitted she was possibly going too fast. There was no damage to her vehicle. I took
photographs of the Nissan and placed them on Evidence.com.
I provided both parties with a case number.
There was no crime. There is no further information available at this time.
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 S. Fajarillo #12847 on 09/04/2023 @ 0554 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. ED95740 CASE# ' 23-10070 DATE AND TIME 08/31/23 14:46
OF COLLISION
V
NOT TO SCALE
PAGE 4 OF 4