HomeMy WebLinkAbout24-2439 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-2439 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 N E IN CITY# ❑
CowsloN 03 - 1-- 2024 1340 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❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2534056515 0 11
30
6� LAST NAME PASTOR FIRSTNAME ALAN MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 1614 182ND ST E CITY SPANAWAY ST WA 2jp, 983871962 z
'NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� D17222D sTArI WAurN# JALCDW164R7016258
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
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 2024 CHEV 4500HD UT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OL.1 EAGLE DISTRIBUTING 1101 N LEVEERD PUYALLUP WA 98371 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 4
14 LIABILITY INSURANCE� CONTINENTAL WESTERN fNSURANCE CPA 605149121
LI EFFECT I POLICY# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING , 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES,/ NO D:9276807168
16 a
LAST NAME WANG FIRST NAME CRYSTAL MIDDLE K
INITIAL
17❑ STREET ❑', 2518 SW 114TH ST CITY SEATTLE ST WA ZIP 981463469 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 LICENSE# STATE WA ]SEX IF M .O.B. 04 12 _ 1983 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
21❑ LICENSE I CKW4052 TArE WA VIN1t 1C4PJMBS6HW638893
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2017 MAKE JEEP MODEL CHEROK STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO CHRISTOPHER POZOULAKIS 2518 SW 114TH ST SEATTLE WA 98146 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 927 602 727IN 1URV'""LE
❑ ,J� CITATION# CHARGELGALYYES N`LJ
25 7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE57081
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2439
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'
On February 29, 2024, at 1503 hours dispatch requested that I respond to a collision that occurred
near Hardie Ave. SW and SW 7th St. in the city Renton, county of king, and state of Washington.
Upon my arrival I spoke with the driver of unit 1 and he explained he was exiting the west parking lot
of Fred Meyer and entering Hardie Ave. SW when the collision occurred. He stated that he did not
see unit 2 driving southbound on Hardie Ave. SW. He proceeded through the northbound lane and
turn lane, striking unit 2's driver and passenger door.
I then spoke with the driver of unit 2 and he explained he had just made a right turn from SW 5th St.
onto Hardy Ave. SW when the collision occurred. He stated he was going southbound on Hardie
when unit 1 exited the parking lot and failed to see him driving southbound. Unit 1 struck his driver
and passenger side door.
The vehicles involved in the collision sustained minor damage so an exchange of information was
given to both drivers.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 03-05-24 07:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 31712024 6:01:23 PM
BADGE OR ID# 12007 OR]# WA0171300 TIME POLICE DISPATCHED', 1:46 PM TIME POLICE ARRIVED',Y:05 PM
PART I PAGE IT]OF
REPORT NO. EE57081 CASE# ' 24-2439 DATE AND TIME 03/05/24 13:40
OF COLLISION
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