HomeMy WebLinkAbout23-12035 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 23-12035 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 O 6 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 10 - 1-- 2023 1119 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
LOGAN AVE S BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4234652552 0 2 30
6❑ LAST NAME HIRD FIRSTNAME STEPHANIE MIDDLE 1 2 31
INITIAL
STREET ❑, 4639 RAVEN BRANCH RD CITy DEL RIO ST TN ZIP 37727 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE TN SEXI F MM D Y' 08 1- 30 - 1984 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H U SE CLA INJURY
1 NATURE OF INJURIES z❑
3
10 9❑ �i aE'rES� 1456KYK sTATe TN vrN# 3C6TRVBG2GE133619
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE
PROMA VNEHICLETOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2016 RAM PROMA VN DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFOSTEPHANIEHIRD 4639 RAVEN BRANCH RD DELRIOTN37727 D:4234652552 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 5410830C3042A 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY
YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2069926410
LAST NAME PRAM FIRST NAME AMY MIDDLE M
INITIAL
17 STREET❑ NEW ADDREss❑' 17911 110TH PL SE CITY RENTON ST WA ZIP 98055 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO
�
19 DRIVER'S STATE WA ]SEX IF D.O.B. 10 _ 08 _ 1980 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# AL V3465 TATE WA VIN# 41
5J8TB4H54DL022216 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
Gov HI
VEH YEAR 2013 MAKE /a C(fR MODEL RDX STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY 44
ES YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILYA101088533 IGQ
5
IN EFFECT
VEHICLE ❑ C—I CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
7TYLER
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
EDIGER 12807 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE13688
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12035
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
PM 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'
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.
TYLER EDIGER 10-21-23 03:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1012712023 4:44:13 PM
BADGE OR ID# 12807 OR]4f WA0171300 TIME POLICE DISPATCHED! 11:22 AM TIME POLICE ARRIVED',11:33 AM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE13688 CASE# 23-12035 OF COLLISION10/21/23 11:19
NARRATIVE
23-12035
On 10/21/2023 at approximately 1122 hours, I was dispatched to a collision at 116 Logan Ave S in
the City of Renton, County of King, State of Washington.
I arrived on scene and observed Unit 1 facing northbound on Logan Ave S, partially blocking the lane.
Unit 1 had significant damage to the front and front drivers side wheel well. I contacted the driver of
Unit 1, and she stated the following:
Unit 1 was traveling northbound and wanted to turn right into the bank parking lot. Unit 1 noticed a do
not enter sign into the parking lot, so she decided to make a U-turn to head south. As Unit 1 pulled to
the right-hand shoulder and began making a U-turn, Unit 2 passed her partially overtaking the
oncoming lane. At this time the vehicles collided. I collected the necessary documentation from Unit 1
and called a tow truck for her.
I contacted Unit 2 who had pulled over to the side of the road after the accident. Unit 2 stated the
following:
She was traveling northbound in the 100 block of Logan Ave S when she observed Unit 1 partially
blocking the northbound lane. Unit 2 stated that she was unsure what Unit 1 was doing, but that it
appeared Unit 1 was parked. Unit 2 tried to pass Unit 1 on the left, at this time Unit 1 began pulling
out and the collision occurred.
As Unit 1 was performing a U-turn in the middle of the road, and Unit 2 passed Unit 1 in a no passing
zone, there is no clear at fault driver at this time.
Unit 1 complained of slight elbow pain and was evaluated by fire.
I provided each party with an exchange of information.
Pictures were taken of each vehicle and uploaded through Axon.
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 T.Ediger 12807 10/21/2023, 1350 hours, Renton, Washington
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REPORT NO.! EE13688 CASE# ' 23-12035 DATE AND TIME 10/21/23 11:19
OF COLLISION
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