HomeMy WebLinkAbout23-13615 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13615 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK EARTH BANK OR LEDGE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 11 - 1-- 2023 0746 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 16TH ST BLOCK NO. e✓ 2600
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069304174 30
6� LAST NAME JOHNSON FIRSTNAME BRIGHT MIDDLE 1 2 31
INITIAL
STREET ❑✓ 1607 PIERCE AVE SE CITY RENTON ST WA Zjp, 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NoF,/
LRIIVER # STATE WA SEXI M MMDDYY
8❑ ' 03 — 23 — 1994 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CEX5545 sTArI WAvIN# 1G1ND52T1W6260856
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
FROM
34
13� VEH.YEAR 1998 MAKE CHEV MODEL MAL/BU STYLE VAMAGE TO YES NOO pLSABLIN TQ yED.BLRS YEES❑ENO
DAMAGE IILLJJII ttSSAA1IVV/it�66
REGISTERED OWNER INFO BRIGHT J0.1911607 PIERCEAVE SE RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ ABILI V INSURANCE INSURANCE CO DIRECT AUTO INS 2016587843 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY ✓ DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2068514352
16❑
LAST NAME THORKILDSON FIRST NAME RICHARD MIDDLE L
INITIAL
17❑ STREET ❑', 2621 SE 16TH ST CITY RENTON ST WA ZIP 98058 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 DRIVE #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE LICENSE vIN# 41
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR 'RLR
UIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I VEHICLELLY ❑ ,.I—I CITATION# CHARGE
25 GQ
LEGA YES N`LJ
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE25463
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13615
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'
Unit 1 was traveling eastbound in the 2600 blk of SE 16th ST. This roadway has a steep incline down
to a left-hand turn. The weather was foggy with temperatures below freezing and portions of the
roadway having reduced traction due to ice. Driver 1 states that as he was traveling and attempted to
apply the brakes, his vehicle began to skid forward without steering control. Unit 1 continued forward
while the road curved to the left. Unit 1 went onto the sidewalk and into a brick earth ledge in the
front yard of 2621 SE 16th ST (Unit 2). Unit 1 sustained moderate and disabling damage. Unit 2
sustained damage to the brick landscaping. Unit 1 towed by Banker's tow.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 11-27-23 01:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 121112023 4:19:36 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED'; 7:48 AM TIME POLICE ARRIVED]7:53 AM
PART I PAGE IT]OF
REPORT NO. EE25463 CASE# ' 23-13615 DATE AND TIME 11/27/23 07:46
OF COLLISION
d1k,
1
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