HomeMy WebLinkAbout24-1003 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-1003 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 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#
COLLISION.. 01 - 1-- 2024 1834 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 10TH ST BLOCK NO. e✓ 5700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NlLEAVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4255259661 0 11
30
6� LAST NAME ARNEY FIRSTNAME KELSO MIDDLE O 1 1 2 31
INITIAL
STREET ❑ 10365 172ND AVE SE CITY NEWCASTLE ST WA 2jp, 980595934 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CKS0323 sTArI WAurN# 3FMCR966XPRE21724
5
----� TRAILER STATE PLA Eft STATE
11 3 PLATE# PLATT E# FR.. ro
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2023 FORD BRONC SV MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO CLINT ARNEY 10165172ND AVE SE NEWCASTLE WA 98059 D:4259859691 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 LIABILITY INSURANCE PROGRESSIVE 922607298
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE to BOTTOM 5 36
LEGALLv YES❑NO❑ CITATION# 5
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:4258915764
16 a
LAST NAME POWERS FIRST NAME TRACY MIDDLE I D
INITIAL
17 STREET❑ NEW ADOREss❑' 5621 NE 5TH CT CITY RENTON ST WA ZIP 980598599 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK vEs It I NOF YES
t l NOF,/
19 LDI IVER # STATE WA SEX M M D.C.B. 09 _ 16 _ 1962 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# A WE1387 TArE 41
WA VIN WAUFGBFCXEN093927 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2014 MAKE /�(fDI MODEL�Q6 STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO,/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DA GEbAREA
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 3628755CO347BIN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE46257
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1003
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) POWERS M/CHELLEA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
5621 NE 5TH CT RENTON WA 980598599 4258915917 SEXi F MMDDYyry 05 - 10 - 1974
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 9 1 USE 2 CLASS I1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O 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.MMDD -❑
YYYY.
PASSENGER SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑WITNESS UNIT# : POS. USE CLASS ----�
NARRATIVE'
On 01/27/2024 at 1837 hours I was dispatched to a blocking collision at the intersection of Nile Ave
NE and NE 10th St in the City of Renton, King County, Washington. I arrived on scene and spoke
with the drivers of Unit's 1 and 2. The driver of Unit 1 stated that he was stopped at the stop sign
facing West on NE 10th St at the intersection of Nile Ave NE, preparing to perform a left hand turn to
proceed South on Nile Ave NE from the 1000 block. Driver 1 stated that he did not see Unit 2 which
was traveling North on Nile Ave NE at around the 1000 block. North and South traffic do not have a
stop sign at the intersection of Nile Ave NE and NE 10th St. The driver of Unit 1 stated that he began
performing a lefthand turn to proceed South on Nile Ave NE from NE 10th St when the front
passenger side bumper of Unit 1 collided with the front and rear passenger side of Unit 2, creating a
large gouge from the front passenger side wheel well to the end of the rear passenger side door. The
driver of Unit 2 stated that he was proceeding North on Nile Ave NE when Unit 1 attempted to perform
a lefthand turn at the intersection of NE 10th St an Nile Ave NE. The driver of Unit 2 stated that Unit
1's front passenger side bumper made contact with the passenger side of Unit 2 starting at the front
passenger wheel well and ending at the rear passenger side door. Both vehicles were operable and
were able to be driven away, no vehicles were towed or impounded. I provided the driver of Unit 1
and 2 with an exchange of information form.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 01-27-24 08:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
JAKE GALL 12617 1 21112024 2:07.43 AM
BADGE OR ID# 12509 ORI# i WA0171300 TIME POLICE DISPATCHED! 6:37 PM TIME POLICE ARRIVED 6:53 PM
PART I PAGE IT]OF 3�
REPORT NO. EE46257 CASE# ' 24-1003 DATE AND TIME 01/27/24 18:34
OF COLLISION
=l
o
PAGE 3 OF 3