HomeMy WebLinkAbout23-13610 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-13610 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 7 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 11 - 1-- 2023 1955 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e NB/405
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2063804745 0 4 30
6❑ LAST NAME AVALOS FIRSTNAME DAVID MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 3814 S 185TH ST CITY SEATAC ST WA Zjp, 98188 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LICENSE# STATE WA SEX'M I ELMMDDYY 02 - 17 - 2001 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 Pi ATNE 14 BZD5330 sTAr WAu N# WBAV833576KR80183
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 7 34
13 A 2006 BMW 330 SD DAMAGE vE8 0NO f �LAWkkRS TOWING vEs❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
A LIABILITY INSURANCE INSURANCE CO 4
14 ❑ OEICO 6121.14.33.71LI EFFECT &POLICY# TOPVEHICLE CHARGE36
LEGALLY Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2069326416
16 a
LAST NAME JOHNSON FIRST NAME JENNE MIDDLE IM
INITIAL
17 STREET NEW ADOREs7 3712 SW TRENTON ST CITY SEATTLE ST WA ZIP 98126 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs❑NoF YES❑NOF-]
19[—] LDI IVE STATE WA ]SEX IF M D.C.B. 05 _ 22 _ 1961 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLATE# 707YNT TArE WA VIN1 3A8FY58959T577845 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2009 MAKE CHRY MODEL PT STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES NO BANKERS TOWING YES NO
REGISTERED OWNER INFO JULIE HATCHER 1240 SW 137TH STAPT495 BURIEN WA 98166 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE❑ &POINSULICY#E CO SAFECOIN 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE io BOTTOM
LEGALLY YES N
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
SLAKE BOWIE 12105 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE25048
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13610
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 11-26-2023 at 1957 hours I was dispatched to the intersection of Susnet Blvd NE / NE 1405, in the
City of Renton, County of King, State of Washington, for a reported blocking collision.
Upon arrival, Unit 1 stated he was driving south on Sunset Blvd NE and Unit 2 pulled out in front of
him instead of yielding. Unit 1 was unable to stop and hit head on with Unit 2. No injuries.
Unit 2 stated she was trying to turn right to get onto 1405 but Unit 1 did not slow down while she was
turning and hit him head on after she attempted to swerve out of the way. No injuries.
There was a "yield" sign at the intersection indicating that Unit 2 was supposed to yield while Unit 1
hade the right of way with no signs.
Both vehicles were towed and both drivers were given an exchange of information which contained
the case number for their records.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electrically signed by Officer B. Bowie / 12105 on 11-26-2023 at 2046 hours in the City of Renton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SLAKE BOWIE 11-26-23 09:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 11/30/2023 4:26:57 PM
BADGE OR ID# ! 12105 ORI#; WA0171300 TIME POLICE DISPATCHED; 7:56 PM TIME POLICE ARRIVED',8:01 PM
PART I PAGE IT]OF 3�
REPORT NO. EE25048 CASE# ' 23-13610 DATE AND TIME 11/26/23 19:55
OF COLLISION
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