HomeMy WebLinkAbout23-14953 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-14953 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 12 - 1-- 2023 1936 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
SUNSET BLVD NE ST e✓
MILEPOST 200 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e NB/405
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:9172503029 0 11
30
6� LAST NAME MERGET FIRSTNAME LEIF MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 1125 LORIMER ST 5F CITY BROOKLYN ST NY ZIP 11222 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER # STATE NY SEX'M MD.
I D Y' 08 - 08 - 2005 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 HELM
U EET 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 AT 14 C74600W STATE WA VIN# 5FPYK3F87H6004921
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 ] 34
13 6 2017 HOND RIDGELI PK DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO IA.MERGET 2110 E PINEST SEATTLE WA 98122 D:3472552508 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
6 INSURANCE CO 4
14 LIABILITY INSURANCE USAA 005295323C71029
LI EFFECT I SUR N# TOPVE—LE CHARGE <1�3
OTTOM 5 36
LEGALLY
res❑NO❑ CITATION# 5
15❑ STANDING 7 6
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:2065797932 N:4252744428
16 2
LAST NAME DALMAR FIRST NAME OMAR MIDDLE
INITIAL
17❑ NEW EET 1:❑' 1224 JEFFERSON AVE NE APT C CITY RENTON ST WA ZIP 98056 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK yyEEsl I I NOF YES
t l NO�
19 DRIVERS
# STATE WA SEX M Mr D.O.B. 01 01 1988 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# BXJ1329 TATE WA VIN# 2T2HA31 U75C064080 41
1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
GI
VEH YEAR 2005 MAKE LEX$ MODEL RX 300 STYLE $V DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU8 PORGY#E CO PEMCO MUTUAL INSURANCE CO CA1260236 1UQ,
5IN EFFECTVE""LE ❑ ,J� CITATION# CHARGEYES N`L J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE37387
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14953
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'
On 12/29/2023 at 1936 hours I was dispatched to a collision at the 200 blk of Sunset Blvd NE. It was
advised over the radio that there were injuries, however, upon my arrival I discovered that there were
no injuries. I spoke with the driver of Vehicle 1 who stated that he was driving Northbound on Sunset
Blvd NE and was proceeding in the #2 lane to turn left onto the NB i405 on-ramp. The driver of
Vehicle 1 stated that he did not see the yield sign which was in front of a bright construction light and
proceeded through the intersection without yielding to the right of way of oncoming traffic. The driver
of Vehicle 1 stated that Vehicle 1's front bumper made contact with the front driver side of Vehicle 2
which was traveling Southbound on Sunset Blvd NE and did not have a stop or yield. The driver of
Vehicle 2 stated that he was traveling Southbound on Sunset Blvd NE at the 200 blk when he
observed Vehicle 1 fail to yield to the right of way. the driver of Vehicle 1 stated that he did not have
time to stop or slow to avoid a collision and the front bumper of Vehicle 1 made contact with the front
driver side of Vehicle 2. The damage I observed on scene was consistent with both drivers stories.
provided both drivers with an exchange of information and both vehicles were towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 12-29-23 09:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 11512024 12:20:13 AM
BADGE OR ID# 112509 OR]# WA0171300 TIME POLICE DISPATCHED, 7:36 PM TIME POLICE ARRIVED 7:42 PM
PART I PAGE IT]OF 3�
REPORT NO. EE37387 CASE# ' 23-14953 DATE AND TIME 12/29/23 19:36
OF COLLISION
m;KKu ;cx
r
v "v— *
PAGE 3 OF 3