HomeMy WebLinkAbout24-797 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4as7 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 01 - 1-- 2024 1808 17 ❑.= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE N BLOCK NO. e✓ 365
4a 2❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
UNIT VEHICLE
MOTZ PEAL-ORCYMLE. El �ESAGE NHORE✓LD MET PHONE 0 9 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCK YES NO YES No
8❑ DRIVERS
STATE SEX u MMDOBYY - 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 HELMET U E 9 CLAY 0 NATURE OF INJURIES 2❑
3
LICENSE sTATI urN#'
10[9 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
rRLR. TRLR. 1 5 33
12 3 5 VIN If VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R T 34
13 2 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065789369
16 a
LAST NAME O'DAY FIRST NAME DANIEL MIDDLE ,I
INITIAL
17❑ STREE EDTR 7 20504 SE 152ND ST CITY' RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT tSENT MEDICAL TRANSPORT � 38
INTERLOCK YEs❑NoR INTERLOCK YES It1 I NOF YES l NO❑
19 D IVEW #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑LICENSE I 21❑ PLA E# CAP2943 TATE WA VIN# 1FAFP55U53(3242895 41
4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2003 MAKE FORD MODEL TAURUS STYLE SD VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DANIELO'DAY20504 SE 152ND ST RENTON WA 98059 D:2065789369 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POLICY#E CO GEICO 6054804262IN 1 9TOP
vE""LE CITATION# CHARGE BOTTOM
LEGALLY YES N�
25❑ s
7CATALAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 12007 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE44309
COLLISION REPORT III III III III III 111
1591972 CASE# 24-797
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 January 23, 2024, at 1808 hours dispatch requested that I respond to a hit and run collision at
Gerber collision and glass, 365 Rainier Ave N, In the city of Renton, county of King, Washington.
Upon my arrival I spoke with the driver of unit 2. They explained they were stopped in traffic facing
southbound on Rainier Avenue north when the collision occurred. The driver stated that they
observed a blue Kia or Hyundai sedan driving at a high rate of speed. Unit 1, failed to come to a
complete stop, driving into the back of his vehicle. The impact was substantial that his vehicle
became immobile and undrivable. The driver of unit 2 also stated that the impact pushed their vehicle
into unit 3 which was also stopped in front of them in the roadway.
After the collision occurred, unit 1 fled the area southbound on Rainier Ave N.
I then spoke with the driver of unit 3 and he explained a similar story. The driver stated he was
stopped in traffic when suddenly he was struck by unit 2 from behind. Unit 3 received minor damage
to their rear bumper, but unit 2 was removed by Bankers towing.
Both drivers refused any medical attention, and I provided them with an exchange of information.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 01-24-24 09:48 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1/25/2024 1:43:40 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED; 6:10 PM TIME POLICE ARRIVED';6:10 PM
PART I PAGE IT]OF 4]
SUPPLEMENTAL REPORT No. EE44309
r`I POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-797
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO
D:2533251352
0 9 29
LAST NAME SAYEDI FIRST NAME : SAYED MIDDLE'.. W
INITIAL
STREET 30
NEW AnDRFSP' 12460 SE 299TH PL CITY AUBURN ST WA ZIP 98092
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:]
YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 12 - 14 - 1986
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE I CKU9168 [TAT WA VIN# 5YFBURHE9EP140952
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2014 MAKE TOYT MODEL COROLL STYLE SD I VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1I' P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO SA YED SAYED112460 SE 299TH PL AUBURNWA98092 D:2533251352 SHADE IN DAMAGED AREA 9 9 33
12 z 3
FROM TO
LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 2021338187 q"i"Olx
IN EFFECT &POLICY# 1
VEHICLE 34
13 2 Lecnuv YES NO❑ CITATION# CHARGE 10 BOTTUM
STANDING } 8 7 6
14 ❑ UNIT Tr Vd 1 RE O FEDDAL 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
El PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
STRE
16 NEW ETETnnR"Fl CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YEs NO YES NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE TAT VIN# 39
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGALLv
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 01-24-24 09:48 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 12007 O#IL WA0171300 JACOBS 1/25/2024 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. EE44309 CASE# 24-797 DATE AND TIME 01/23/2418:08
OF COLLISION
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CD
a
ay
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