HomeMy WebLinkAbout23-10498 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 3 27c
COLLISION REP FIT 1591971
CASE 23-10498 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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# ❑
cawsloN 09 - 11 - 2023 1104 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE N BLOCK NO. e✓ 1000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 75 00 FEET MILES e S B W e N 10TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:4258023022 0 81
30
6� LAST NAME MILLER FIRSTNAME RICHARD MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 12016 87TH AVE NE CITY KIRKLAND ST WA Zjp, 980346014 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI aT�S1t BBX2823 sTAr� WAvIN# JTDZN3EUXD3275451
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# ROM ro
TRLR. TRLR 1 5 33
12 0 0 VIN#' VIN#
;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 2 2013 TOYT PRIUS V DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO RICHARD MILLER 1211687TH AVE NE KIRKLAND WA 98034 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO SAFECO H1969248
IN EFFECT &POLICY# 9TOP
VE"'CLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2069202573
16 a
LAST NAME WONG FIRST NAME SOLANA MIDDLE M
INITIAL
17❑ STREET , 12550 120TH AVE NE#725 CITY SEATTLE ST WA ZIP 981783982 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVE STATE WA ]SEX IF MMDDW 04 19 _ 1989 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE ACY0881 TAre I WA VIN1t 1FMCU9D7XAKB94969
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE FORD MODEL ESCAPE STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24 DAMAGE YES 1/ NO GENE MEYER YES NO
REGISTERED OWNER INFO KIM TSO 8310 S 115TH LN SEATTLE WA 98178 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 6025997344IN 1 GD
VEHICLe CITATION# CHARGE
LEGALLY YES[Z N�
25❑ JAGENCY
s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE01701
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10498
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CAMAR/LLO-REYES KART
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
9736 NE 119 WAY E201 KIRKLAND WA 98034 2066040804 SEXi F MMDDYyry 03 - 21 - 1993
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 4 1 USE 2 CLASS 1
NAME
'(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
Ex Isl MMDDYYYV
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'
Unit 2 was stopped for a red light on southbound Logan AVE N at N 14th ST. Unit 1 was approaching
N 10th ST southbound on Logan AVE N. Driver 1 was apparently disoriented and unaware of his
surroundings or where he was. Driver 1 stated he is possibly suffering dementia and was attempting
to travel from Kirkland to Bellevue for a doctor's appointment and did not know how he got in Renton.
Driver 1 did not recognize that traffic was stopped and continued southbound into Unit 2. The front
end of Unit 1 struck the rear end of Unit 2 causing moderate but disabling damage to both vehicles.
Driver 1 transported to the hospital for evaluation of his medical conditions. Both Unit 1 and Unit 2
towed by Gene Meyer tow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 09-11-23 01:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 9/23/2023 8:51:04 PM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED 11:09 AM TIME POLICE ARRIVED 11:09 AM
PART I PAGE IT]OF 3�
REPORT NO.! EE01701 CASE# ' 23-10498 DATE AND TIME 09/11/23 11:04
OF COLLISION
N 10�h ST
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