HomeMy WebLinkAbout23-14971 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-14971 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 0123 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N BLOCK NO. e✓ 800 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 8TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064197989 0 11
30
6� LAST NAME JONES FIRSTNAME ROBERT MIDDLE A 1 1 2 31
INITIAL
STREET ❑I 530 BURNETT AVE N APT 10 CITy RENTON ST WA 2jp, 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YES R NoF,/
LRIIVER # STATE WA SEX'M MI MIT Y
8❑ ' 03 - 05 - 1955 1 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 9 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CHW1466 sTArI WAvIN# JM1N6353230308926
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR 2003 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 MAZD MX-5 CP DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 4
14 LIABILITY INSURANCE FARMERS 194708260
LI EFFECT I SUR N# TOPVEHCLE CHARGE <1�3
OTTOM 5 36
LEGALLY YES NO CITATION# 3A0754271 INATTENTIVE DRIVING 5
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2062284938
16 a
LAST NAME PRAM FIRST NAME TUYET MIDDLE T
INITIAL
17 STREET ITH AVE S CITY' SEATTLE ST' WA ZIP 98118 4❑ 37
NEW ADOREs�' 9832 55
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C... 10 _ 28 _ 1960 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CFF8762 TArE 41
WA VIN# JTMRJREVOJD154859 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
TOWED BY GOV HI 44
VEH YEAR 2018 MAKE 7'Dy7' MODEL RA V4 STYLE $V DAMAGE TOWED TOO✓ BLIN YES NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO PEMCO CA2066199IN 1GVE""LE
TOP❑ ,J� CITATION# CHARGE OTTOM
LEGALLY YES N`L J
25
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. EE48775
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14971
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 12/31/2023 at 0125 hours I was dispatched to a 2 vehicle blocking collision near the intersection
of N 8th St and Logan Ave N. The driver of Vehicle 1 was complaining of chest pain and Renton
Regional Fire Authority was called to evaluate Driver 1. Driver 1 was cleared medically at the scene.
Driver 1 stated that he was traveling South on Logan Ave N at around the 800 block in the number 1
lane. Driver 1 said that he was tired and must have fallen asleep at around the 800 block. Driver 1
stated that Vehicle 1's front bumper made contact with the rear bumper of Vehicle 2. This caused
minor damage to Vehicle 2 and me the damage threshold for Vehicle 1. The driver of Vehicle 2 stated
that she was traveling South on Logan Ave N at the 800 block in the number 1 lane. Driver 2 stated
that as she proceeded through the intersection, Vehicle 1's front bumper made contact with the rear
bumper of Vehicle 2. Both vehicles pulled to the right side of the roadway. I provided both drivers with
an exchange of information form.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 12-31-23 02:53 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 2/9/2024 3:58:41 PM
BADGE OR ID# 112509 ORI#' WA0171300 TIME POLICE DISPATCHED 1:25 AM TIME POLICE ARRIVED 1:25 AM
PART I PAGE IT]OF 3�
REPORT NO. EE48775 CASE# 23-14971 DATE AND TIME 12/31/23 01:23
OF COLLISION
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