HomeMy WebLinkAbout23-14439 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-14439 z
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 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 - 1-- 2023 1400 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 743
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET MILES e S B W e S 7TH ST
0 1 29
MOTU '�01 VEHtOCLEZ PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs No�/ YEs No�/
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 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 sTAT1 urN#'
10[ PI ATE#
TRAILER TRAILER
STATE STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 0 0 vIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 9 ALMA UNKNO UT DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 1 5 36
LECALLv YeS❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES No 1/ D:2065325205
16 a
LAST NAME CALHOUN FIRST NAME OMAR MIDDLE R
INITIAL
17 STREET I6❑' 110 WILLIAMS AVE S#301 CITY RENTON ST WA ZIP 98057 37
NEW ADOREs
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YES It1 I NoF t l YES NO
19 LICENSE# STATE WA SEX M M D.O.B. 01 13 _ 1984 El 39
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
❑ILICENSE 21❑ PLATE# BTW0010 TATe 41
WA vIN# 1C4NJCBA9GD753622 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2015 MAKE JEEP MODEL CONFAB STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ASHLEE ANDERSON 10507194TH ST CT E GRAHAM WA 98338 D:2533169229 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 532-6442-A27-47AIN 1UQI
VE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.STEED 8770 WA0171300
PART A PAGE 01 OF
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE31230
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14439
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ANDERSON ASHLEE J
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
10507 194TH ST CT E GRAHAM WA 98338 2533159229 SEXi F MMDDYyvv 05 - 24 - 1996
PASSENGER WITNESS❑;UNIT# 2 POS 3 AIRBAG 2 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES
USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) JOHNSON JAYLA R
ADDRESS&PHONE# D O B
10507 194TH ST CT E GRAHAM WA 98338 SEX F MMDovvvv 11 _ 25 _ 2016
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 PGS 7 AIRBAG 2 RESTR. 10 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) JOHNSON GIA B
ADOREss&PHONE# 10507 194TH ST CT E GRAHAM WA 98338 U 11 29 _ 2019
SEX. D.O.B. _
MMDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT 7 AIRBAG 2 RESTR. 10 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES
POS. USE CLASS SOREHEAD
NARRATIVE'
On 12/16/23 at about 1432 hrs I arrived in the area of 743 Rainier Ave S for a hit and run report, in
the City of Renton, County of King, and State of Washington. The driver of Unit#2 advised he was
now at 150 SW 7th St for suspect contact. Driver#2 advised while they were in the parking lot of
Walmart a Dark Blue SUV hit the front driver's side of their bumper with the front passenger side
bumper. He described the male driver as black, wearing a beanie and blue jacket. He said the jacket
had Toyota written on it and he believed he was an employee at Bob Bridge Toyota next to Walmart.
I checked with a general manager and the service manager and they both advised there was not an
employee who was driving a blue SUV matching that description. I checked the back lot of the
dealership and did not find any blue SUVs with damage to the front passenger side bumper. The front
passenger of unit#2 advised her daughter in the left rear seat complained of head pain after the
collision. There is no further suspect information.
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 12/16/23 1645 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 12-16-23 04:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
J.TRADER 4553 12/16/2023 6:46:20 PM
BADGE OR ID# 8770 OR]# WA0171300 TIME POLICE DISPATCHED; 2:25 Pry TIME POLICE ARRIVED',2:32 PM
PART I PAGE IT]OF 3�
REPORT NO. EE31230 CASE# ' 23-14439 DATE AND TIME 12/16/23 14:00
OF COLLISION
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