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Home My WebLink About23-11467 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-11467 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4250 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 7 28 TOTAL#OF OBJECT TRIBAL UNITS 03 STRUCK' FENCE RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ GawsloN 10 - 1-- 2023 1145 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE SUNSET BLOCK NO. e✓ 3500 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ MILES❑ FEET e S ❑ W e PIERCEAVENE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2064196768 0 11 30 6� LAST NAME BRADHAM FIRSTNAME WILLIAM MIDDLE W 1 1 2 31 INITIAL STREET ❑, 1631 EDMONDS AVE NE CITY RENTON ST I WA ZIP 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 6 CLASS 0 NATURE OF INJURIES z❑ 3 10 9❑ P1 ATNES# D810098 STATE WA VIN# 1FTCR10A6VUD13720 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 0 0 VIN#' VIN# FROM 34 VEH.YEAR 1997 MAKE FORD MODEL RANGE STYLE VEHICLE TOWED No pLSSBLIN TSIYY.Ep9vMEYER YES[:]DAMAGE ILJI (�ciV6 13 REGISTERED OWNER INFO WILLIAMBRADHAM1631EDMONDSAVENERENTONWA98056 D:2064196768 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILI INSURANCE INSURANCE CO INSURANCE 3 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STAIN.D'ING 7 6 UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES NO OLD MET PHONE 16 a LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY RENTON ST ZIP 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑ 19 LLIICENS RIVEWS# STATE SEX U MMDDYY 39 WELMET 1NJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑ ❑21❑ TATE LICENSE VIN# 41 PLATE# 42 22❑ PIR TRAILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR MAKE MODEL STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY Gov YES N HIO 44 24❑ YES REGISTERED OWNER INFO UNKNOWN RENTON VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGQ'E""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. EE10851 COLLISION REPORT III III III III III 111 1591972 CASE# 23-11467 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) DUNLAP ROBERT W (LAST FIRST, ADDRESS&PHONE# 2538599460 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# D O E:4 SEX MMDDYYYY PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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 10/06/23 1 responded to a hit and run collision that occurred on NE Sunset Blvd and Pierce Ave Ne. I contacted the driver of unit 1 who told me they were traveling in the #1 lane of eastbound NE Sunset Blvd when they were hit on the rear drivers-side of their vehicle. The impact caused the driver to lose control of his vehicle and crash into the fence and home located at 1500 Piece Ave Ne. The driver was not injured during the collision. The homeowner was not available in person. I left an information exchange print out for the owner. The suspect vehicle was described as a black pick up truck and according to a witness, was last seen continuing eastbound on NE Sunset Blvd. The witness could not identify the suspect driver. 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 10-10-23 12:05 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 1011912023 10:46:19 AM BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED; 11:45 AM TIME POLICE ARRIVED 11:50 AM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EE10851 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-11467 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:4253709499 MIDDLE.. 29 LAST NAME OMOTUNDE FIRST NAME DAYO INITIAL STREET 30 NEW AnDRFSP' 1500 PIERCE AVE NE CITY RENTON ST WA ZIP 1 911057 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]Na� YEs N DRIVER'S STATE I SEX U M��DYSYv' —� 2 LICENSE 7F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NEn+AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VEHICLE EFFECT &POLICY# I 970P - 4 44 24 VEHICLE YES NO❑ CITATION# CHARGE iq 60TiOM E:l C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. J.MITCHELL 10-10-23 12:05 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 10377 O#I',WA0171300 JACOBS 10/19/202 PAGE F OF 4 3000-345-013(R 11118) REPORT NO.! EE10851 CASE# ' 23-11467 DATE AND TIME 10/06/23 11:45 OF COLLISION W z 4 L1 d � tL W 0. { NE SUNSET BLVI PAGE 4 OF 4