HomeMy WebLinkAbout23-11224 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-11224 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 09 - 1-- 2023 1653 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
e✓ --- ----�
N 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ 10 00 FMILES NEET e S ❑ E e GARDEN AVE N
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2064549615 0 11
30
6❑ LAST NAME HARRISON FIRSTNAME BRYSON MIDDLE W 1 2 31
INITIAL
STREET ❑, 440 MAPLE AVE SW APT A102 CITY RENTON ST WA Zjp, 98057 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'M MID
-O B 06 1- 24 - 1984 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CFU0861 sTArI WAurN# 4JGDA5J65JB153115
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE 3 ] 34
13 1 2018 MERZ GLE UT DAMAGE YES NO � g MEYERS ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO ALLSTATE 820414005 3 4
IN EFFECT &POLICY# 9TOP
LEwcLe CHARGE 1 5 36
LEcnLLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062612472
16 a
LAST NAME JACKSON FIRST NAME LEXXIE MIDDLE A
INITIAL
17 STREET IENNETT ST CITY' SEATTLE ST' WA ZIP 98118 37
NEW ADDREs�' 3545 S B
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-TRANSPORTED 38
INTERLOCKYES�NO INTERLOCK yEEsl I I NOF YES
t l NO�
19� LICENSE STATE WA ]SEX IF M D.C.B. 03 _ 31 1958 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BYZ9214 TArE WA VIN# 41
JTHFF2C23A2501308 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2010 MAKE LEXS MODEL IS 250 STYLE CP DAMAGE TOWED NOO✓ BLIN TOWED By ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO TRAVELERES 6032559882031IN IUL"iKOTITIfl0l�-
�R"VE—LE ❑ ,J� CITATION# CHARGELGALLYESN`L J25 7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
GROZAV 12489 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE06438
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11224
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HUTSON DEBORAH L
(LAST FIRST,
ADDRESS&PHONE#
3545 S BENNETT ST SEATTLE WA 98118 SEX U MMDOYyry 06 - 03 - 1956
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET CLASS NATURE OF INJURIES
❑✓ [] 2 POS. 3 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O 8
SEX MMDDYVYV
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'
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.
BRYAN GROZAV 09-30-23 06:23 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 101612023 12:36:14 PM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED; 4:53 PM TIME POLICE ARRIVED',4:57 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EE06438 CASE# 23-11224 OF COLLISION
09/30/23 16:53
OF CbLLI510N
NARRATIVE
CASE 23-11224
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.
On Saturday September 30th, 2023, at approximately 16:53, 1 responded to a 911 call regarding a
two-vehicle collision at N 4th St and Garden Ave N within the City limits of Renton, King County,
Washington.
***CALL REMARKS: 2 MVA, UNK INJS. BLKG WB IN INTERSECTION, FLASHERS ON
-UNIT ONE: BLACK 2018 MERCEDES BENZ GLE WASHINGTON LICENSE: CFU0861
-UNIT ONE DRIVER: BRYSON W. HARRISON (DOB: 6.24.1984)
-UNIT TWO: BLACK LEXUS IS WASHINGTON LICENSE: BYZ9214
-UNIT TWO DRIVER: LEXXIE A. JACKSON (DOB: 03.31.1958)
1 arrived on scene and checked with Bryson and Lexxie for injuries. They indicated they were not
injured. Lexxie had a front passenger at the time of the crash who indicated she was not injured just
shaken up. Bryson and Lexxie were both driving west on N 4th St, a one-way street. Bryson indicated
he was going to change lanes and did not see Lexxie in the left lane next to him because the sun was
in his eyes. As he changed lanes he crashed into Lexxie.
Lexxie indicated the same thing happened, Bryson tried to change lanes and crashed into her
vehicle. Both vehicles had damage that was consistent with what Bryson and Lexxie said occurred.
Bryson's vehicle needed to be towed from the scene since it was inoperable.
I provided Bryson and Lexxie a copy of the SECTOR exchange of information form.
This concludes my involvement in this case.
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 B. Grozav #12489 on 9.30.2023 at 18:21 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE06438 CASE# 23-11224 DATE AND TIME 09/30/23 16:53
OF COLLISION
N 4th St
Garden Ave N
PAGE 4 OF