HomeMy WebLinkAbout23-11886 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-11886 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#TRIBAL OF OZ OBJECT 1 O 6 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 10 - 1-- 2023 2203 17 ❑-= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO.
1❑ e ❑
MILEPOST
4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e SW V/CTOR/A ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES ✓NO D:2064769514 0 2 30
6❑ LAST NAME GREEN FIRSTNAME BREEZY MIDDLE N 1 2 31
INITIAL
STREET ❑ 6804 S 123RD ST,APT 87 CITY SEATTLE ST WA 2jp, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 10 1— 03 — 1979 2 32
[NATURE OF IN
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H USE 2 7 CLASS HEAD PAIN JURIES 2❑
3
10 9❑ Pi ATE 14 BJH9059 STATE WA VIN# 1 FMYU03195KB85880
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 5 7 33
12 0 VIN#' VIN#'
:: FROM TO
VEH.YEAR 2005 FORD ESCAPE 4D MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO BREEZY GREEN 6804 S 123RD ST,APT 87 SEATTLE WA 98178 D:2064769514 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 ❑ 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064766928
16 a
LAST NAME IBRAHIM FIRST NAME JAWAHIR MIDDLE A
INITIAL
17 NEW STREETR 3723 S 7 OTHELLO ST CITY SEATTLE ST' WA ZIP 98118 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 LDIIVERS STATE WA SEX F M .C.B. 04 27 1991 39
20❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 HE 2 INJURY 7 NATURE of INJURIES ❑ 40
USE CLASS CHEST PAIN
❑21❑ PLATE# CHN6070 TATE 41
WA vIN# 5TDZARAH8LS500258 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GoI
VEH YEAR 2020 MAKE 7'Dy7' MODEL yIGHLAN STYLE 5D DAMAGE TOWED NOO✓ BLIN TOWED BY v HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 817839432IN STOP 5
VE—LE ❑ ,J� CITATION# CHARGE
25 to BOTTOM
LEGALLY YES N`L J
OQ
s � a
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10998
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11886
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PHILLIPS ASHLEY
(LAST FIRST,
ADDRESS&PHONE#
--RENTON 2534866528 SEXi F MMDDYyry 06 - 29 - 1989
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYVYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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'
Unit 1 was traveling north bound on Rainier ave S, approaching the intersection of Rainier Ave S and
SW Victoria street. Unit 1 began to make a left turn from the left most lane. Unit 2 was proceeding
north bound on Rainier ave S in the left most lane, Unit 2 proceeded to attempt to pass Unit 1 in the
opposing lanes of traffic. Unit 2 then collided into Unit 1.
Unit 1 had significant damage to the driver's side of their vehicle, the axle of the front left wheel was
destroyed. Unit 1 had head pain but no other injuries. Unit 1 had no proof of insurance at the time of
incident but stated she did have current insurance on the vehicle. I notified her to provide the
insurance to Unit 2 at a later time otherwise she would be cited.
Unit 2 had minor front end damage to the passenger side of her vehicle. Unit 2's driver stated she had
chest pain.
A witness of the incident, Ashley Phillips stated that she did not see the initial collision but observed
the direct aftermath. She stated that she observed Unit 2's vehicle in the oncoming lanes of travel
directly after the collision with Unit 1.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 10-18-23 01:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 1011912023 4:47:09 PM
BADGE OR ID# 12650 OR]# WA0171300 TIME POLICE DISPATCHED' 10:03 PM TIME POLICE ARRIVED'10:06 PM
PART I PAGE 2�OF❑
REPORT NO.! EE10998 CASE# 23-11886 DATE AND TIME 10/17/23 22:03
OF COLLISION
co
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