HomeMy WebLinkAbout24-1420 ITFF' "POLCERA II I !�� I III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
SASE 24-1420 2
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 2 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'. 02 - 1-- 2024 1518 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
UNION AVE NE BLOCK NO. e✓ 421 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e NE 4TH ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252833795 0 11
30
6� LAST NAME DAHM FIRSTNAME FRED MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 4004 NE 4TH ST STE 106 C{Ty RENTON ST WA Zjp, 980564102 z
NEW ADDRESS
7❑ 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 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATE 14 AKM9862 JBTATIJ WAu N If WBSBL93406PN63979
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 7 5 33
12 0 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13❑2 ZOO6 BMW M3 SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO FRED DAHM4004 NE41H STSTE 106 RENTON WA 980564102 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE� INSURANCE E CO TRAVELERS INSURANCE 6147993592031 4
LI EFFECTIPOLICY# TOPVEHICL GE 36
LECALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY I DAM THR OLD MET PHONE
VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4259026578
16 a
LAST NAME ALVAREZ FIRST NAME ARIANA IN DOLE $
IN MIDDLE
17❑ STREET ❑', 3305 BURNETT AVE N CITY RENTON ST WA ZIP 980561930 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19[—] DRIVER'S STATE WA ]SEX IF D.C.B. 10 _ 17 1998 0 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE BRX4334 TAre 41
WA VIN# 19UUA66268A051584
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2006 MAKE ACUR MODEL TL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ARIANA ALVAREZ 3305 BURNETTAVE N RENTON WA 980561930 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 951065174IN 1GQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
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. EE50267
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1420
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 8, 2024, at 1518 hours, dispatch requested that I respond to a collision near the
intersection of NE 4th St and Union Ave NE.
Upon my arrival I spoke with the driver of unit 1, and he explained he was exiting the parking lot of
Fire Stone (421 Union Ave NE) when the collision occurred. The driver of unit 1 planned on making a
left turn from the Firestone, to go northbound on Union Ave NE. Another vehicle travelling
southbound slowed to a stop, opening a gap in traffic for unit 1 to pass through. As unit 1 proceeded
through the gap, unit 2 was in the left lane. Unit 1 failed to notice unit 2, striking their passenger
doors.
Unit 2 recalled a similar story. The driver stated they were going southbound on Union Ave NE and
approaching the intersection when the collision occurred. The driver of unit 2 was attempting to make
a green turn arrow when unit 1 drove into her passenger side doors.
The vehicles sustained damage over$1000. Both drivers refused medical attention and no vehicles
were towed away from the scene.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 02-08-24 04:45 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 2/13/2024 11:26:04 AM
BADGE OR ID# 12007 ORI# WA0171300 TIME POLICE DISPATCHED 3:20 PM TIME POLICE ARRIVED 3:24 PM
PART I PAGE IT]OF 3�
REPORT NO. EE50267 CASE# ' 24-1420 DATE AND TIME 02/08/24 15:18
OF COLLISION
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