HomeMy WebLinkAbout24-6259 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-6259 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
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# ❑
CtLLISION' 06 - 14 - 2024 1307 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO. e✓ --- ----�
TALBOT RD S MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 30 00 FEET MILES e S B W e S GRADYWAY
0 1 29
UNIT MOTOR
� PEDAL-
CYCLE ❑ YESAGE NHORESHOLD MET PHONE 0 8 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑
NEW ADDRESS CITY SEATTLE ST ZIP z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8 DRIVER'S. STATE SEX.M D.Q.E. 1 1 2 32
❑ :LICENSE# MMDDYY =—
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EET 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE CGJ5189 sTArI WAurN If 3GKFK16R2XG500333
10❑ PI ATE 14
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. A'RLR. 1 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
13 4 1999 GMC SUBUR DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO RONNIE PARKER 401 S TRENTON ST SEATTLE WA 98108 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ NDING 6
UNIT 02
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2096128205
16 a
LAST NAME SIGILLO FIRST NAME KATINA MIDDLE IM
INITIAL
17 STREET❑ NEW ADOREss❑' 11221 SE PETROVITSKY CITY RENTON ST WA ZIP 98055 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK v�Es No� YEs NDF
19 D IVERI #
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS WHIPLASH AND DIZZY
LICENSE I ❑21❑ PLA E# BLN4084 TArE 41
WA VIN# JHMGESH67AS018829 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE HOND MODEL FIT STYLE 4T VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KATINA SIGILLO 11221 SE PETROVITSKY RD RENTONWA98055 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 807503056IN I GD
VEHICLE CITATION# CHARGE
LEGA YES[Z N�
25❑ LLY JAGENCY
s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE88251
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6259
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'
Driver of unit 2 flagged me down at the station and informed me she was in a hit and run collision
which took place at Talbot Rd S and S Grady Way.
She said she was stopped facing north on Talbot Rd S and she was the third vehicle stopped in lane
3 on a red light. Unit 2 was rear ended by unit 1. After the collision unit 1 merged to lane 2 and fled
northbound through the intersection without stopping to exchange information or checking on the
welfare of the driver of unit 2.
The driver was described as a black male in his 30s with short 3 inch braids. Driver of unit 2 said she
can identify the suspect driver at a later date.
While with me the driver of unit 2 felt like she had whiplash and felt dizzy. Fire was called and said
she did not need to be taken to the hospital. I followed her to urgent care and she later told me she
was diagnosed with a concussion and was given anti-inflammatory medication.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 06-16-24 11:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 6/19/2024 2:19:02 PM
BADGE OR ID# 10065 OR]# ': WA0171300 TIME POLICE DISPATCHED', 4:97 Pry TIME POLICE ARRIVED',1:17 PM
PART I PAGE IT]OF 3�
REPORT NO. EE88251 CASE# ' 24-6259 DATE AND TIME 06/14/24 13:07
OF COLLISION
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