HomeMy WebLinkAbout23-6225 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-6225 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
GawsloN 06 - 01 - 2023 1545 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 4300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e WHITMAN CT NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:8082220096 0 11
30
6� LAST NAME PILGER FIRSTNAME AARON MIDDLE P 1 1 2 31
INITIAL
STREET ❑ 2207 SE 2ND PL CITY RENTON ST WA ZIP 980568866 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 3 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10[1P1 ATNES# ATU1315 sTAr WAv N# 5UXCR6C55K!l04048
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2019 MAKE BMW MODEL X5 STYLE VEHICLE TOWED 0 TO ffBLIN T,AW7jBLRS TOW VEHICLE
3 7 34
DAMAGE ILJI tSA1Wlc
13 REGISTERED OWNER INFO .RONPILGER2.1SE2NDPL RENTONWA98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO USAA 081688100C 71029 4
IN EFFECT &POLICY# 9TOP
vECALLv HICLE 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15 LE❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5053049090
16 a
LAST NAME SMITH FIRST NAME AERIK MIDDLE I J
INITIAL
17❑ STREET ❑', 6408 NE 1ST ST CITY' RENTON ST WA ZIP 980598591 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YES t l NO❑
19 DCENS STATE WA SEX M MMr C.B. O6 _ 19 _ 2005 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CER3368 TAre WA VIN1i 3FA6POHR6DR387500
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
TOWED BY Gov HI 44
VEH YEAR 2013 MAKE FORD MODEL FUSION STYLE —TEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 14930327 7104IN 9TOP 5
VE""LE ❑ Nu,J CITATION# CHARGE io BOTTOM
LEGALLY YES
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED70714
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6225
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) KLEEBERGER AUSTEN R
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
3519 NE 7TH PL RENTON WA 98056 SEX M MMDDYyry 08 - 19 - 2005
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 6 4 1 USE CLASS !1
NAME
(LAST,FIRST,MIDDLE INITIAL) PEARMAN JOHN H
ADDRESS&PHONE# D O B
18437 SE 135TH ST RENTON WA 98059 SEX M MMDO-w 11 _ 09 _ 2004
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 POS 9 AIRBAG 6 RESTR. 4 EJECT 1 USE CLASS 1
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'
On 06012 at approximately 1545 1 responded to a 2-vehicle non-injury/blocking collision NE 4th
St/Whitman Ct NE.
Upon arrival I contacted the driver of unit 1 (D1) who told me they were eastbound NE 4th in the left-
turn lane at Whitman CT NE. D1 says his traffic signal displayed a yellow blinking arrow and his
vehicle was slightly over the solid white stop line. D1 says once the light displayed a solid yellow
arrow, he began to make the left turn and was involved in a collision with unit 2. D1 says he made
the left turn after he observed a white vehicle in lane 1 of westbound NE 4th St come to a complete
stop. D1 says he believes the driver of unit 2 was initially following the white car in lane 1 of
westbound NE 4th and switched to lane 2 to get through the traffic signal. The driver of unit 1 was not
injured. The vehicle was towed due to damages (passenger front side).
I contacted the driver of unit 2 (D2) who told me there were traveling in the #2 lane of westbound NE
4th when he was involved in a collision with unit 1. D2 says he travelled through the intersection on a
solid yellow light and D1 turned in front of him. D2 says he was driving 30-40 mph when he entered
the intersection. There were no reported injuries in unit 2, which along with the driver, was carrying
two additional passengers. Unit 2 was towed due to damages (front end and other).
No witnesses came forward or called in reference this collision.
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 06-06-23 11:37 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 6/16/2023 8:28:30 AM
BADGE OR ID# 10377 ORI#', WA0171300 TIME POLICE DISPATCHED 3:45 PM TIME POLICE ARRIVED 4:00 PM
PART I PAGE 2�OF❑
REPORT NO. ED70714 CASE# ' 23-6225 DATE AND TIME 06/01/23 15:45
OF COLLISION
NOT TO SCALE
FR=Final Rust
Pal-Point of Inibal Contact
WH ITMAN CT N E
Cn
2
H
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