HomeMy WebLinkAbout23-10799 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-10799 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 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 09 - 19 - 2023 1800 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
TAYLOR AVE NW e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OF RENTON AVE EXT
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:8475050007 0 11
30
6❑ LAST NAME DOPPELT FIRSTNAME DEBORAH MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 13915 OLD COAST RD UNIT 1501 CITY NAPLES ST FL ZIP, 341108734 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LICENSE# STATE FL SEX'F MM D Y' 02 - 26 - 1961 1 2 32
9 1❑ ON DUTY❑ STATUS' AIRBAG' 4 RESTR 4 EJECT 1 HELMET
2 INJ CLASS 7 INJUREDFKNEE INJUR ES z❑
3
10❑ Pi aTES� BUE6615 sTArI WAvIN# 4S3GTAV69L3718996
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /[g GOVT.VEHICLE 7 3 34
13 2020 SUBA IMPREZ DAMAGE YES No � '` RS TOW YES❑ No✓
REGISTERED OWNER INFO JOSH.DOPPELT 154112TH AVE S APT 8 SEATTLEWA98144 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE z INSURANCE CO FIRST NATIONAL INSURANCEZ5035656
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7744541119
16 a
LAST NAME DURR FIRST NAME MADISON MIDDLE P
INITIAL
17 STREET❑ NEW ADOREss❑' 889 POINT RD NONE CITY' MARION ST MA ZIP 027381216 4❑ 37
18❑ CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YES
t l NO�
19 D IVEW # STATE MA SEX IF Mr D.O.B. 01 13 _ 1996 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# 2EVZ79 TArE MA VIN 1t 3C6TRVDGXKE513247 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
TOWED BV Gov HI 44
VEH YEAR 2019 MAKE RAM MODEL AROMAS STYLE 7EHICLE
TOWED✓ NOO BLIN BANKERS TOW YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 984251743IN STOP 5
VE""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE13479
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10799
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DOPPELT PAUL S
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
13915 OLD COAST RD UNIT 1501 NAPLES FL 341108734 8475070007 SEX M MMDOYyry 02 - 09 - 1962
PASSENGER I�I WITNESS❑',UNIT# 1 P 3 AIRBAG 2 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES
Lv 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX: MMDDYYVY
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.
MMDDYYYY. -
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.
JAKE GALL 09-19-23 08:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1012712023 1:58:51 AM
BADGE OR ID# 12617 OR]#' WA0171300 TIME POLICE DISPATCHED! 6:22 Pry TIME POLICE ARRIVED',6:26 PM
PART I PAGE IT]OF 4�
REPORT NO. EE13479 CASE# 23-10799 OF COLLISION
09/19/23 18:00
OF CbLLI510N
NARRATIVE
*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. *
The following occurred within the City of Renton, King County WA and was recorded on my body
worn camera.
On 09/19/2023 at around 1820 hours, I was dispatched to an injury accident located near at the
intersection on Taylor Ave NW and Renton Ave Ext.
I arrived on scene and located both vehicles pulled off to the side of the road North of the intersection.
Vehicle 1 had extensive damage to the driver side door and quarter panel. Vehicle 2 had damage to
it's front bumper.
I contacted vehicle 1 and driver 1 who was able to provide all the necessary information. Driver 1
stated that she was traveling Northbound in lane 1 of 1 through the intersection and was distracted by
looking at the street signs. Driver 1 stated that she ran though the red light at the intersection. Vehicle
2 impacted vehicle 1's driver door as vehicle 1 was halfway through the intersection. Vehicle 1
driver's airbags were deployed and was later towed by Banker's towing. Driver 1 complained of knee
pain. Renton Fire offered her an icepack. The passenger of vehicle 1 was uninjured and provided the
same story as the driver.
I contacted vehicle 2 as well as driver 2. She was able to provide all the necessary information
needed. Driver 2 confirmed driver 1's story. Driver 2 was driving East on Renton Ave Ext in lane 2 of
2 though the intersection. Driver 2 had the green light and impacted vehicle 1 as it went through the
intersection. Driver 2 was uninjured.
Both driver's were provided with an exchange of insurance info sheet.
Both vehicles were towed by Banker's towing.
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 J. Gall/12617
09/19/23 at 2017 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO.! EE13479 CASE# ' 23-10799 DATE AND TIME 09/19/23 18:00
OF COLLISION
cc
***NOT TO SCALE
}
PAGE 4 OF 4