HomeMy WebLinkAbout23-14233 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-14233 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F E: LOCAL AGENCI 4250 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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 12 - 11 - 2023 2037 17 �. S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW 43RD STREET BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OF EAST VALLEY ROAD
0 1 29
UNIT MOTOR
E Z CYVEHICCLE ElDDAMYESA✓NGE THR OESHOLDMET PHONE 0 3 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE [1 —ll 31
INITIAL
STREET ❑
NEW ADDRESS CITY SUMNER ST ZIP z
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No YES No
8❑ LICIENSE#
STA fE I
SEX u MMDOBYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R 1 34
13❑ DAMAGE YES NO VES❑ NO
REGISTERED OWNER INFO [NEW] VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO w' '
IN EFFECT &POLICY#VENICLE CHARGE 36
LECALLv YES❑NO CITATION#15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2536531105
16 a
LAST NAME TIERNAN FIRST NAME LOIS MIDDLE A
INITIAL
17 STREET I❑ 15520 63RD STREET CT E CITY' SUMNER ST WA ZIP 98390 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PR-E- tSENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES It1 I NOF YES l NO❑
19 D IVE
I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
LICENSE ❑21❑ PLA E# CAJ0252 TATE 41
WA VIN# JF2SKAJC4MH563093 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2021 MAKE SUBA MODEL FORESTS STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV!TN
44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO LOIS TIERNAN 1552063RD STREET CT E SUMNER WA 98390 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE 8 POINSURGY#E CO ALLSTATE 964090748IN I 9TOP
VEHICLE YES❑ N,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY $ '
7ESAGIAO
S NAME(PRINT) OFFICER PHONE BADGE OR ID# [AGENCY
26
10339 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE31229
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14233
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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.SAGIAO 12-11-23 11:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 12/16/2023 6:31:02 PM
BADGE OR ID# 10339 ORI# WA0171300 TIME POLICE DISPATCHED; 8:41 PM TIME POLICE ARRIVED',8:45 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE31229 CASE# 23-14233 OF COLLISION12/11/23 20:37
NARRATIVE
On 12-11-23 at 2041 hours I was dispatched to a hit and run at the intersection of East Valley Road
and SW 43rd Street, in the City of Renton, King County, State of Washington. The reporting party
was Unit#2 who requested contact in the parking lot of the Spot Pub off East Valley Road. They
relayed the other vehicle had left the scene.
I arrived and contacted Unit#2 which was a green 2021 Subaru Forester (WA-CAJ0252) registered
to a Lois Tiernan. She was also the driver and I identified her by her WA DL. She advised the
following to me verbally.
She drove downhill from the hospital on SW 43rd Street. She drove westbound on SW 43rd Street.
She reached the light and slowed down to check if traffic was clear to make the right turn to go
northbound on East Valley Road. When she did this, she was rear ended by an older white colored
sedan.
Both vehicles stopped in the lane and Tiernan advised a Hispanic male in most likely his twenties
exit the driver side of Unit#1. He was about 5-7 tall with a medium build he told Tiernan he did not
have insurance and asked for her number. During this incident, a third party had yelled at them to
clear the street. The suspect driver advised Tiernan he would text her the information she needed.
She never received the text and the male who she described as well-mannered left the location. She
advised he did ask if she was OK.
Tiernan said Unit#1 was an older white sedan with heavy front-end damage as a result of the
collision. She provided a partial plate of AKH574. I tried several different variations but could not find
a match. Some colors are not listed on DOL returns of vehicles. Tiernan told me she would be able to
identify the suspect driver if she saw him again.
Unit#1 failed to exchange pertinent information with Unit#2 after being in a collision. I provided
Tiernan a business card with this case number.
The damage to Unit#2 was to the rear of the vehicle with damage mostly on the rear passenger
side. There was a damaged rear light, the body was misaligned and there was white paint transfer to
the rear of the vehicle all consistent with Tiernan's account.
The incident was captured on my body worn camera. The report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
I certify or declare under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
E.Sagiao/10339
PAGE 3 OF 4
REPORT NO. EE31229 CASE# 23-14233 DATE AND TIME 12/11/23 20:37
OF COLLISION
East Valley Rd
i
"E
Street
PAGE 4 OF 4