HomeMy WebLinkAbout23-14272 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-14272 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 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# ❑
cowsloN 12 - 1-- 2023 1420 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 7TH ST BLOCK NO. e✓ 300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2069459042 30
6� LAST NAME OWENS FIRSTNAME CRYSTAL MIDDLE C F 2 31
INITIAL
STREET ❑ 9113 50TH AVE S UNIT C CITy SEATTLE ST WA 2jp, 981185064 z=
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEX'F MID
.O B 01 - 16 - 1983 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CCV9752 sTAr� WAvIN# 1C4PJLLBXKD463141
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12❑ VIN#' VIN#.
"; FROM TO
VEH.YEAR 2019 MAKE JEEP MODEL CHERO STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
DAMAGE YES NO ✓ YES[:] NO✓
13❑ REGISTERED OWNER INFO CRYSTAL OWENS 111350THAVE S UNITC SEATTLE WA 98118 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vewcLe CHARGE 1 5 36
LEGALLY YES NO CITATION# 10 BOTTOM
15❑ STAIN,DIING MOT8 7 6
UNIT U2 vEHIOCLE ❑ CYCLE ❑ PEDESTRIAN PROPERTY❑PEDAL ✓ OWNFR ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME FRIEL FIRST NAME RYAN MIDDLE S
INITIAL
17❑ STREET NEW ADOREss❑' HOMELESS OFF 7TH AND NACHES CITY' RENTON ST ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCK YES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIICENS RIVERS# STATE I SEX M MMDDYY -=_ 39
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT , HELMET INJURY 6 NATURE OF INJURIEs 40
USE CLASS HEAD/FACE
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 Q ] DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
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. EE33297
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14272
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MACKO ROGER
(LAST FIRST,
ADDRESS&PHONE#
2532296672 SEX' M MMDDYYYY -❑
---------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYVYV
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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'
On 12/12/23 1 responded to a vehicle versus pedestrian collision near the 300 block of SW 7th St.
I contacted the driver of unit 1 who told me they were traveling in the #2 lane of westbound SW 7th
St. As the driver was approaching a pedestrian walkway, she hit a pedestrian with the passenger
sideview mirror. The driver says she did not see that the pedestrian had started walking across SW
7th. The vehicle's passenger side mirror was damaged.
I contacted the pedestrian as he was being treated by Renton Fire. He had visible injuries to his face
(lacerations, swelling). The pedestrian who says he was homeless, refused to seek additional
treatment at a hospital. He said he would go seek treatment later if needed.
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 12-19-23 09:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 12/22/2023 7:57:33 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 2:20 PM TIME POLICE ARRIVED',2:25 PM
PART I PAGE 2�OF❑
REPORT NO. EE33297 CASE# ' 23-14272 DATE AND TIME 12/12/23 14:20
OF COLLISION
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