HomeMy WebLinkAbout24-5039 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-5039 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 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 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# ❑
COLLISION'. 05 - 11 - 2024 2050 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK M0 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET ❑ S ❑ W❑ UNION AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252723903 0 11
30
6� LAST NAME BJARNO FIRSTNAME ETHAN MIDDLE M 1 1 2 31
INITIAL
STREET El5516 NE 2ND ST CITY RENTON ST WA 21p 980594868 z
NEW ADDRESS
7❑ CDL I
IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO INTERLOCK YES No YES No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
❑10❑ Pi aT�S� AQV6520 sTArI WWAurN# JHt RE48577C093949 3
TRAILER STATE TRAILED STATE
11 3 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 5 7 33
12 3 0 VIN#' VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 1 $ 34
13 2 2007 HOND CRV DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO MORRIS MOSER 5511 NE 2ND ST RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO AMERICAN FAMILYAX01454254
IN EFFECT &POLICY# 9TOP
15❑ vEHLE 5 36
LEGALLICY YES�No D CITATION# 4A0202168 CHARGE FAIL YIELD LEFT TURN MOTOR io eorrom
STANDING 8 7 6
MOTOR PEDAL-: PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2067510535
16 a
LAST NAME DANOWSKI FIRST NAME RUTH MIDDLE O
INITIAL
17❑ STREET �', 13622 97TH AVE NW CITY GIG HARBOR ST WA ZIP 98329 37
NEW ADDRESS I I I I I ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
IN7ERLOCKYES�NOR INTERLOCK YEs❑NOF YES
❑NoF,/
19 D IVERI # STATE WA SEX F Mr D.O.B. 10 _ 30 _ 1961 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE CLV7516 TAre 41
WA YIN# 4S3BK6350T7301120
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
TOWED BY Gov HI 44
VEH YEAR 1996 MAKE S(JB�Q MODEL LEGACY STYLE 7EHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO VEHICLE ❑ C[:] CITATION# CHARGEC�Ql
LEGALLY YES N`LJ
25 s � a
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. EE76812
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5039
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) COSTA NICHOLAS
(LAST FIRST,
ADDRESS&PHONE#
RENTON 3609827233 SEX i U MMDDYyry - -
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' MMDDYVYV
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 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 northbound on Union AVE NE approaching the intersection with NE Sunset
BLVD with the intention to turn left onto westbound NE Sunset BLVD. Unit 2 was traveling
southbound on Union AVE NE approaching the intersection with NE Sunset BLVD with the intention
to travel straight through southbound on Union AVE NE. Witness states Unit 2 had a green light for
southbound Union AVE NE and Driver 2 stated she saw a green light. Driver 1 stated that he thought
he had a green arrow for his left turn, but this could not be possible with Unit 2 having a green light,
though Northbound traffic would have a green light as well but the left turn must yield. Unit 1 initiated
the left turn, not yielding to Unit 2, and turned into the path of Unit 2. The front end of Unit 1 struck
the front end of Unit 2 causing moderate/heavy disabling damage to both vehicles and airbag
deployment in Unit 2. No injuries were reported in either vehicle. Both vehicles towed by Bankers
Tow.
Driver 1 cited for failure to yield to a motor vehicle while making a left turn by initiating a left turn in
front of Unit 2, traveling with the right of way, which was the proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 05-12-24 02:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 5/14/2024 8:03:43 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 8:51 PM TIME POLICE ARRIVED i 8:54 PM
PART I PAGE 2�OF❑
REPORT NO. EE76812 CASE# 24-5039 DATE AND TIME 05/11/24 20:50
OF COLLISION
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