HomeMy WebLinkAbout23-14192 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-14192 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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#
cawsloN 12 - 11 - 2023 0746 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 7TH STREET BLOCK NO. e✓ 700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e DAYTON AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069205917 0 11
30
6� LAST NAME OLIVA FIRSTNAME HECTOR MIDDLE A 1 2 31
INITIAL
STREET ❑ 2205 NE 6TH PL CITy RENTON ST WA ZIP 980563607 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑
USE CLASS j I LEFT SHOULD AND ARM PAIN
3
10 9❑ PI ENSE BZF4562 STATE WA VIN#' 4S4WMAFDXM3452682
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34
13 2 2021 SUBA ASCENT P4 DAMAGE vE6 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO HECTOR OLIVA 2205 NE 6TH PL RENTON WA 980563607 D:2069205917 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI VINSURANCE INSURANCE CO STATE FARM 5222571-COI.47A
IN EFFECT &POLICY# 9TOP
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LE STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4259496238
16 a
LAST NAME FAWCETT FIRST NAME STEVEN MIDDLE G
INITIAL
17❑ STREET NEW ADOREs6❑' 949 ABERDEEN AVE NE C108 CITY RENTON ST WA ZIP 98056 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEB❑No� INTERLOCK ves No� YES NOF
19 DRIVER'S STATE WA SEX M D.C.B. 07 � 10 _ 1987 39
LICENSE# MMDC7YY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H EET 2 NJAURSY 6 HAND,WRIST AND ARM PAIN ❑F—NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BAC9645 TATE 41
WA VIN# 1FMCU9G97EUB64917 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2014 MAKE FORD MODEL ESCAPE STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO DANIELLE CALL 949 ABERDEEN AVE NE RENTON WA 98056 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY INSURANCE INSU&PORGY#E CO GEICO 4368160034 4103124 9TOP 5
IN EFFECT
"'LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
DES/REE SCOTT 10272 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE29363
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14192
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) FAWCETT MALCOLM R
(LAST FIRST,
ADDRESS&PHONE# D O.B.
949 ABERDEEN AVE NE C108 RENTON WA 98056 SEX M MMDDYyry 09 - 19 - 2021
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS, 7 2 10 1 USE CLASS 0
NAME
(LAST,FIRST,MIDDLE INITIAL) FAWCETT KINGSTON
ADDRESS&PHONE# D O B
949 ABERDEEN AVE NE C108 RENTON WA 98056 SEX M MMDDYvvv 11 _ 05 _ 2019
SEAT HELMET I INJURY NATURE of INJURIES
PASSENGER Z WITNESS❑ UNIT# 2 POS 9 AIRBAG 2 RESTR. 10 EJECT 1 USE CLASS 1
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'
On 12/11/23 around 0746 hours I was dispatched to the 700 block of Dayton AVE NE (City of Renton,
County of King, and State of Washington) due to a report of a vehicle collision involving two vehicles.
Upon arrival I contacted Driver#1 who stated he was headed Westbound on NE 7th ST and went to
take a left hand turn to go South onto Dayton AVE NE. Driver#1 turned his turn signal on, and did
not see any traffic so he started his left hand turn. Driver#1 said he was struck by Vehicle #2. Driver
#1 said he did not see Vehicle #2 and believes that the vehicle #2 did not have its headlights on.
Driver#1 stated when the accident occurred it was Dawn, but still dark, and foggy and raining out
today. Driver#1 stated his left shoulder and arm hurt. Driver#1 declined aide and stated he would
go see his doctor later. Vehicle #1 had significant damage to the passenger side rear door, quarter
panel, tire, and bumper.
Driver#2 stated he was headed Eastbound on NE 7th ST when Vehicle #1 turned in front of him.
Driver#2 slammed on his brakes but was unable to avoid the collision as Vehicle #1 was in his lane
directly in front of him. Driver#2 had pain to his hands, wrists, and arms. No injuries were reported
for passengers in Vehicle #2. Vehicle #2 had significant damage to the passenger side bumper,
engine, hood, quarter panel and tire.
Both vehicles were towed 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.
DESIRES SCOTT 12-11-23 09:34 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIREE SCOTT 10272 1211112023 6:29:54 PM
BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED; 7:54 AM TIME POLICE ARRIVED',8:01 AM
PART I PAGE 2�OF❑
REPORT NO. EE29363 CASE# 23-14192 DATE AND TIME 12/11/23 07:46
OF COLLISION
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