HomeMy WebLinkAbout24-481 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE 24-481 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 02 STRUCK' RETAINING WALL
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 01 - 14 - 2024 1330 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 5400
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES❑ 200 00 FEET e S ❑ W e 145TH PL SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:7604812597 30
6� LAST NAME SKIBICKI FIRSTNAME REBECCA MIDDLE 1 2 31
INITIAL
033 SUNSETBLVDNEAPT7 CITY RENTONSTSTREET ❑ WA 2jp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YES R NoF,/
LICENSE# STATE WA SEX'F M .O B 03
$❑ — 21 — 1966 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10❑ P1 ATE 14 CDK5026 STATE WA v N# 3N1CN7AP4KL872970
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12❑ VIN#' VIN#.
Rom 34
13� VEH.YEAR2019 MAKE NISS MODEL VERSA STYLE SD VEHICLE TOWEDNOOpLSABLIN TQyEq.BLRs yOS❑ENO
DAMAGE IILLJJII tSA1Vi�6
REGISTERED OWNER INFO REBECCA SKIBICKI 1033 SUNSETBLVD NEAPT7 RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO STATE FARM 5123290-D09.47 4
IN EFFECT &POLICY#
VE"'CLE CHARGE 5 ❑ 36
LEGALLY YES❑NO❑ CITATION# BOTTOM
15❑ STAIN.D'ING 6
UNIT VE IOOR El CYCLEPEDAL- ❑ 2]PEDESTRIAN ❑ PROPERTY DYES NO ✓OLD MET PHONE
16❑
LAST NAME FIR GROVE MOB&PARK FIRST NAME MIDDLE
INITIAL
17 STREET❑ NEW ADOREsS❑' 5323 NE SUNSET BLVD CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX U MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEV/N PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE44662
COLLISION REPORT III III III III III 111
1591972 CASE# 24-481
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BICE BRENDAN
(LAST FIRST,
ADDRESS&PHONE# D O.B.
4253943427 SEX' U MMDDYYYY -❑
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
[:]WITNESS❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYV
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
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'
I was dispatched to the collision on 01/14/24 at 1332 hours at 5400 block of NE Sunset Blvd in city
Renton, King County WA.
Unit 1 CDK5026 Driver Skibicki, Rebecca (03/21/1966)
Property Owner Fir Grove Mobil Home
Rebecca was identified by her WADL.
Unit 1 was traveling West on NE Sunset Blvd when approaching the 5400 block she fell asleep
behind the wheel. When approaching the curve, she went straight off the road and into a rock wall
causing her vehicle to roll over. Unit 1 said they were up since 0300 hours and just fell asleep.
There was mild damage to the rock wall.
Rebecca was seen by fire on scene no injurys reported.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 01-14-24 06:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 1/26/2024 3:27:51 PM
BADGE OR ID# 1Y808 OR]# ': WA0171300 TIME POLICE DISPATCHED 1:32 PM TIME POLICE ARRIVED 1:38 PM
PART I PAGE IT]OF 3�
REPORT NO. EE44662 CASE# ' 24-481 DATE AND TIME 01/14/24 13:30
OF COLLISION
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