HomeMy WebLinkAbout23-10593 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-10593 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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# ❑
GawsloN 09 - 1-- 2023 1145 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 74
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S B W e S TOBIN ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2065864911 0 7 30
6� LAST NAME WASSE FIRSTNAME JOHANNA MIDDLE T 1 1 2 31
INITIAL
STREET ❑, 1670 S ROBERTO MAESTAS FESTIV CITY SEATTLE ST WA ZIP, 98144 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 EJECT 1 H U SE INJURY -, [NATURE
CLASS 7 I KNEES OF INJURIES z❑
3
10 9❑ Pi aT�S� CBL1691 sTArI WAvIN# JTDBR38E042024132
----� TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2004 MAKE TOYT MODEL COROL STYLE VEHICLE TOWED 0 TOO
ffBLIN T,QVWkkRS yOS❑ENICLE O✓ 9 9 34
DAMAGE ILJI tSA1Wl6
13 REGISTERED OWNER INFO JOHANNAWASSE5411158THPLSW EDMONDSWA98026 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4
14❑ LIABILITY INSURANCE❑ INSURANCE CO 3
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES NO CITATION# 3A0387750 INATTENTIVE DRIVING 1 o Borrow
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:IF NO ,/ D:2065930622
16 a
LAST NAME MURA FIRST NAME LEONID MIDDLE N
INITIAL
17❑ STREET ❑', 10026 NE 127TH PL APT D116 CITY KIRKLAND ST WA ZIP 980348810 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 DRIVER'S STATE WA SEX M D.C.B. 02 _ 07 1995 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE A6658352 TAre WA vIN# 5FNYF4H54A8504515
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
LE Y
TOWED eY GOV HI 44
VEH YEAR 2010 MAKE HOND MODEL PILOT EX STYLE DAMAGE TO WED NOO✓ BLIN YES NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE I PORGY#ECO AMERICAN FAMILY INS 410325172160 1 STOP
IN EFFECT
'E""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES Nu
❑ s
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. EE01707
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10593
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 091423 1 responded to a 2-vehicle non-injury/non-blocking collision at 74 Rainier Ave S
I contacted the driver of unit 2 who told me they stopped for traffic in the #2 lane of northbound
Rainier Ave S when they were rear-ended by unit 1. The driver was not injured.
I contacted the driver of unit 1, identified as Johanna Wasse (dob 08-29-93) via her WA DL (online).
Wasse confirmed she rear-ended unit 2 as she traveled northbound on Rainier Ave S. Wasse says
she tried to stop before rear-ending unit 2. Wasse was seen by Renton Fire for observation purposes
due to front airbag deployment. Wasse was unable to provide proof of insurance at the time. I gave
her my business card so that she could email it to me by the end of the day.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Wasse via SECTOR under RMC 10.12.25-Inattention
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 09-14-23 03:26 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 9/23/2023 8:51:44 PM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED! 11:45 AM TIME POLICE ARRIVED';11:50 AM
PART I PAGE IT]OF 3�
REPORT NO.! EE01707 CASE# ' 23-10593 DATE AND TIME 09/14/23 11:45
OF COLLISION
N
S TOB;IN ST
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