HomeMy WebLinkAbout24-798 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4ass 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CtLLISION' 01 - 1-- 2024 1759 17 ❑-= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e✓ 100 ❑
4a 2❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e RAINIER AVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255232600 0 9 30
6� LAST NAME BATTLES FIRSTNAME TOM MIDDLE F 1 2 31
INITIAL
STREET ❑ 495 RENTON CENTER WAY#207 CITY RENTON ST WA ZIP 98057 2
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ PIATE14 /a0A04ET sTAr At vN# 1G1ZD5ST6NF141863
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 1 5 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
13 2 2024 CHEV MAL/BU SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO EAN HOLDINGS LLC 5900 MESSER AIRPORT HWY BIRMINGHAM AL 35212 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO SELF INSURED 4
LI EFFECT I POLICY# TOPVENICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2065508542
16 a
LAST NAME WHITE FIRST NAME JANET MIDDLE ID
INITIAL
17 STREET❑ NEW ADOREss❑' 3203 19TH AVE S CITY SEATTLE ST WA ZIP 98144 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NO❑
19 DRIVER # STATE WA SEX F M D.O.B.
02 _ 04 1950 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BSN0060 rare 41
WA VIN# WVGSV7AX8HK005506 1
42
22❑ PLATE# STATE PLATE ILER# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2017 MAKE VOLK MODEL TIGUANS STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JANET WHITE 320319TH AVE S SEATTLE WA 98144 D:2065508542 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO AARP 55PHK445735IN I STOP
vE""LE CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N�
❑ J s
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE44310
COLLISION REPORT III III III III III 111
1591972 CASE# 24-798
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SCOTT EDDIE M
(IAST FIRST,
ADDRESS&PHONE#
214 S 48TH ST#F RENTON WA 98055 SEXi F MMDDYyry 10 - 01 - 1938
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 4 1 USE 2 1 CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
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'
On January 23, 2024, at 1759 hours dispatch requested that I respond to a collision that occurred at
Rainier Ave N and Airport Way, in the city of Renton, county of King, Washington.
Upon my arrival I spoke with the driver of unit 1. The driver explained he was approaching the
intersection but failed to come to a complete stop. The driver stated his legs felt weak and could not
lift his foot from the accelerator.
I then spoke with the driver of unit 2 and they explained a similar story. They stated they were
stopped in southbound traffic on Rainier A N when the collision occurred. They explained that unit 1
failed to come to complete stop, hitting the back bumper of their vehicle.
Unit 1 sustained damages over $1000 it also deployed several airbags at the front of the vehicle. The
vehicle was removed by bankers towing and both drivers were given a copy of the 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 1:42:41 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED; 8:02 Pry] TIME POLICE ARRIVED';6:40 PM
PART I PAGE IT]OF 3�
REPORTNO.! EE44310 CASE# 24-798 DATE AND TIME 01/23/2417:59
OF COLLISION
AirportWay
Unit 1
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