HomeMy WebLinkAbout23-14415 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE35796 170
27
COLLISION REP FIT 1591971
CASE 23-14415 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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#
cowsloN 12 - 1-- 2023 1900 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE S BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e S 132ND ST
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2063595443 0 11
30
6� LAST NAME KAJI FIRSTNAME MARGARET MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 10400 66TH AVE S CITY SEATTLE ST WA 21p 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 08 1- 07 - 1976 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CCK9985 sTArI WAurN#' JF2GFAPC9M8240829
10❑ PI ATE 94
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 1 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2021 SUBA CROSST SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 1 34
13 4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO SAFECO H2333348 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:5073508616
16 2
LAST NAME CHAIRAKOUN FIRST NAME LUCKY MIDDLE P
INITIAL
17 NEW EET --' 350 SENECA AVE NW CITY RENTON ST WA ZIP 98056 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVE
STATE MN SEX M M .C.B. O6 _ 23 _ 2003 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# GDA083 TArE 41
WA VIN# KL79MSSL3MB155163 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2021 MAKE CHEV MODEL TRAIL STYLE PK -TEHICLE
TOWED✓ NOO BLIN GENE MEYERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE� &POINSURGY#E CO STATE FARM 4684650-E}8-23AIN STOP 5
VE-LE ❑ ,J CITATION# CHARGE
25 io BOTTOM
LEGALLY YES Nu
' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JASON TURNER 12650 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE35796
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14415
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'
Unit 1 and 2 were traveling northbound on Renton Ave S, approaching S 132nd ST. Unit 1 was
traveling in the left lane, Unit 2 was traveling in the right lane. Unit 1 signaled right to merge into the
right lane, while merging Unit 1 turned directly into the front of Unit 2's vehicle. This caused Unit 1 to
spin out and collide further with the front of Unit 2's vehicle.
Neither driver reported having any injuries. Unit 1's vehicle had extensive damage all over the
vehicle, well above reportable damage. Unit 1 had a combination of airbag deployments, multiple flat
tires, and extensive damage to the body of the vehicle. Unit 1 was not driveable so a personal tow
was called to the scene.
Unit 2 had extensive damage to the front bumper of the vehicle but the vehicle was still driveable.
An exchange of information was given to both parties.
Unit 1 caused the collision by performing an improper lane change, turning their vehicle directly into
Unit 2's vehicle.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 12-15-23 10:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 12/31/2023 1:10:00 AM
BADGE OR ID# 12650 ORI#' WA0171300 TIME POLICE DISPATCHED' 7:00 Pry TIME POLICE ARRIVED 7:08 Pry
PART I PAGE IT]OF
REPORT NO. EE35796 CASE# ' 23-14415 DATE AND TIME 12/15/23 19:00
OF COLLISION
PAGE 3 OF 3