HomeMy WebLinkAbout24-5761 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE83100 170
27
COLLISION REP FIT 1591971
CASE 24-5761 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 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 05 - 1-- 2024 1438 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
NE SUNSET BLVD e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑ W e❑ FEET MONROE AVE NE
0 3 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/ENHORESHOLDMET PHONE 0 8 30
6� LAST NAME JOHNSON FIRSTNAME LARRY MIDDLE F 1 2 31
INITIAL
STREET ❑ 529 SM►THERS AVE S APT A CITY RENTON ST WA ZIP' 980572510 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 02 1— 28 — 1942 2 32
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H USEET 2 CLASS 7 [NATURE OF
UNKNOWNNJURIEs z❑
3
10❑ Pi aTS DP69067 sTAr WA V N# JTLZE4FEXA1099106
----� TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 3 1 33
12 0 0 VIN#' VIN#i
;.... FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2010 TOYT SCION 4T DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO LARRYJOHNSON 529SMITHERS AVE S APTA RENTON WA 980572510 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO MUTUAL OFENUMCLAW PA41131900
IN EFFECT &POLICY# �1'OP
AR
VEwcLE GE CH ❑ 36
LEGALLY Yes❑NO❑ CITATION# BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES�/ No D:4254963311
16 a
LAST NAME LARSON FIRST NAME CHRIS MIDDLE I C
INITIAL
17❑ STREET ❑', 10503 126TH AVE SE CITY RENTON ST WA ZIP 980563253 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 03 _ 24 1958 0 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE AZD2296 TAre WA VIN# JS2Y8413875103571
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2007 MAKE SUZJ MODEL SX4 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SPENCER WILSON 10503126TH AVE SE RENTON WA 98056 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO USAA 004153923 7102IN 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES N
$ '
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE83100
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5761
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) FLOOD TOM
ADDRESS&PHONE#
UNK. RENTON WA 2063962430 SEX i U MMDDYyry 12 - 04 - 1959
PASSENGER WITNESS UNIT# SEAT ' AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYV
PASSENGER []WITNESSO UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On May 31, 2024, at 1438 hours dispatch requested that I respond to a collision at the intersection of
NE Sunset Blvd and NE 12th St, in Renton. The reporting party reported that a vehicle had just rolled
over after hitting another vehicle.
Upon my arrival I spoke with the driver of unit 2 and he explained he was facing eastbound on NE
12th St, attempting to make a left turn onto NE Sunset Blvd when the collision occurred. He saw unit
1 make a wide right turn, so he moved forward to avoid a collision. Unit 1 still struck his driver's side
rear bumper. In doing so, he lost control of the vehicle and struck a tree that was near the entrance to
Rite Aid.
The driver of unit 1 appeared to be having a medical episode, so he was transported to Valley
Medical Center. I did not question him.
A witness stated a similar story to the driver of unit 2. They stated that the driver of unit 1 lost control
after hitting a stopped vehicle in traffic. Unit 1 then lost control of the vehicle and struck a tree, which
turned the vehicle upside down.
An exchange of information was given to both drivers and unit 1 was removed from the location by
Bankers Towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 05-31-24 05:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 6/3/2024 11:05:47 AM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 2:38 Pry] TIME POLICE ARRIVED f 2:53 PM
PART I PAGE IT]OF 3�
REPORTNO.! EE83100 CASE# 24-5761 DATE AND TIME 05/31/2414:38
OF COLLISION
NTS
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