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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 ***NOT TO SCALE*** z �a PAGE 3 OF 3