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HomeMy WebLinkAbout23-10854 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 23-10854 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AOENC 4Y00 3 HIT&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# ❑ GowsloN 09 - 1-- 2023 0730 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SW 43RD ST BLOCK NO. e✓ 1200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 50 00 FMILES EET e S ❑ W e OAKESOALE AVE SW 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4258912363 0 11 30 6� LAST NAME SANTOS-ARELLANO FIRSTNAME SIMON MIDDLE 1 2 31 INITIAL STREET 01 10835 SE 200TH ST APT 3 CITY KENT ST WA 2jp, 98031 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LICIENSE# STATE yyq SEX'M MM DI,Y' 03 — 19 — 1999 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 ATNES# CHR9213 sTAr WAuN# JF1GD70684L519047 5 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR 2004 MAKE SUBA MODEL IMPREZ STYLE VEHICLE TOWED 0 TOO ffBLIN TSIgWgYMEYER YOS❑ENIC O 3 7 34 DAMAGE ILJI (�ciV6 13 REGISTERED OWNER INFO SIMONSANTOS-ARELLANO10835SE200THSTAPTA3 KENT WA98031 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP 5 36 veH'CLe CHARGE LEGALLv YEs❑NO❑ CITATION# 10 BOTTOM 15❑ 1N.D" 8 6 UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES [:]I DYES NO SOLD MET PHONE 16 a LAST NAME GEARY FIRST NAME JOSHUA MIDDLE A INITIAL 17❑ STREET ❑', 511 S 55TH ST CITY' RENTON ST WA ZIP 980556343 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 LDIIVER # STATE WA SEX M MMDDW 02 _ 26 _ 1980 0 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CFV7438 TAre WA vIN1t 4T1C11BKXPU084485 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. GI VEH YEAR 2023 MAKE 7'Oy7- MODEL CAMRY STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 44 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE 8 POINSURGY#E CO USAA 0188732 90UIN 1 9TOP 5 """LE ❑ N`L J ,J� CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES $ ' 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. EE02084 COLLISION REPORT III III III III III 111 1591972 CASE# 23-10854 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) W/SWELL SH/GEM/JENNIFER L (LAST FIRST, ADDRESS&PHONE# 14700 SE PTROVITSKY RD#A301 RENTON WA 980588967 2066178953 SEXi F MMDDYyry 12 - 13 - 1980 PASSENGER WITNESS UNIT# SEAT AIRBAG; RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES �✓ 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 R PHONE# SEX D.O.B. - MMDDYYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' On 092123 1 responded to a 2-vehicle non-injury/ blocking collision at SW 43rd St and Oakesdale Ave SW. I contacted the driver of unit 2 who told me they were traveling westbound in the #1 lane of SW 43rd when they felt contact on the back end of their vehicle. Driver was uninjured during the collision. His vehicle was drivable but had medium damage to the back-driver side bumper and quarter panel. I contacted the driver of unit 1 who told me they were traveling westbound in the #2 lane of SW 43rd approaching the intersection at Oakesdale Ave Sw. Driver says he approached the intersection on a fresh yellow light. Driver says there was a vehicle making a left turn from westbound SW 43rd to northbound Oakesdale Ave Sw. Driver says to avoid a collision with that unit, he swerved right and ended up contacting the lane 1 curb with his back right wheel before ricocheting off of unit 2. His vehicle finally came to rest in the eastbound turn lane. The driver was uninjured. Unit 1 suffered damage to the passenger side and was towed by Gene Meyers. I contacted the witness who told me she was traveling westbound in the #1 lane of SW 43rd approaching the traffic signal at Oakesdale Ave Sw. Witness says she saw unit 1 enter the intersection on fresh red light, swerve to avoid a vehicle turning northbound on to Oakesdale, hit the lane 1 curb, bounce off unit 2 and come to rest. But not for the action of UNIT 1 DRIVER the result would not have happened. 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 09-22-23 09:08 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 9/25/2023 9:54:47 AM BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED! 7:30 AM TIME POLICE ARRIVED 7:35 AM PART I PAGE IT]OF 3� REPORT NO. EE02084 CASE# 23-10854 DATE AND TIME 09/21/23 07:30 OF COLLISION OAKES©ALE AVE SW SW 43RD PAGE 3 OF 3