HomeMy WebLinkAbout23-13314 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE21125 170
27
COLLISION REP FIT 1591971
CASE 23-13314 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I 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 RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cowsloN 11 - 18 - 2023 1350 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 43RD ST BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e SR 167
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2532287276 0 11
30
6� LAST NAME SCHAFF FIRSTNAME BRIAN MIDDLE M 1 1 2 31
INITIAL
STREET ❑1 1412 LAKE YOUNGS WAY SE CITY RENTON ST WA 2jp, 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'M I ELMIDI Y' 09 — 18 — 1983 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CDt5638 sTAr� WAvIN# 1G1RE6E4XEU164727
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 3 7 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 ] 34
13 3 2014 CHEV VOLT 4D DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 900904530 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069450940
16 a
LAST NAME GARCIA MENDOZA FIRST NAME YOLANDA MIDDLE L
INITIAL
17❑ STREET ❑', 11453 SE 162ND ST CITY RENTON ST WA ZIP 98055 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX F MMDDW O6 _ 15 _ 1999 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CHX7151 TAre WA VIN# 1C4RJFBG8CC115451
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
GoI
VEH YEAR 2012 MAKE JEEP MODEL GRAND STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO pROGRESSIVE 952314078IN IULlliKOTlTlfll;0-
ME'E""LE ❑ ,J� CITATION# CHARGEYES N`L J25 OFFICER'S NA (PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.STEED 8770 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE21125
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13314
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
PM 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 11/18/23 at about 1416 hrs I arrived in the 200 block of SW 43rd St for a Collision Report that
occurred in the 100 block of S 43rd St, in the City of Renton, County of King, and State of
Washington. Unit#1 was traveling WB in the outside lane of S 43rd St in the lane that merges on to
NB SR 167. Unit#2 was traveling WB in the middle lane that continues WB on S 43rd St. Unit#1's
driver advised he quickly changed lanes and did not see Unit#2. Unit#2's driver advised she had just
changed lanes into the middle lane when she saw Unit#1 changing lanes into her, but she was
unable to avoid the collision. Both parties advised they were not injured.
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized. The video was uploaded to evidence.com.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed by Officer Steed on 11/18/23 1504 hrs, Renton Washington
Cassidy Steed/8770
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.STEED 11-18-23 03:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 11/19/2023 10:36:33 AM
BADGE OR ID# 8770 OR]# WA0171300 TIME POLICE DISPATCHED 2:10 PM TIME POLICE ARRIVED',2:16 PM
FART I PAGE IT]OF 3�
REPORT NO. EE21125 CASE# ' 23-13314 DATE AND TIME 11/18/23 13:50
OF COLLISION
SR 167
W 43rd St
, f( "
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