HomeMy WebLinkAbout24-1622 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-1622 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 — 14 — 2024 0905 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD N BLOCK NO. e✓ 350
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254355115 0 11
30
6� LAST NAME DAVIS FIRSTNAME AMANDA MIDDLE E 1 1 2 31
INITIAL
STREET ❑, 15300 SE 155TH PL UNIT C103 CITY RENTON ST WA 2jp, 980588315 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 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BQS0711 sTArI WAurN# 1HGFA16576L089168
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2006 HOND CIVIC SD DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO AMANDA DAVIS 15300 SE 155TH PL,UNITC103 RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO NONE 3 4
IN EFFECT &POLICY#VE—LE CHARGE 36
LEGALLv Yes❑NO❑ CITATION# U�,
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:3605134292
16 a
LAST NAME FROMEL FIRST NAME EZEKIEL MIDDLE ,/
INITIAL
17❑ STREET ❑', 806 SE 153RD AVE APT B CITY VANCOUVER ST WA ZIP 986831340 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 #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CGJ5692 TAre WA vIN# 1GNDT13WOV2182543
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 1997 MAKE CHEV MODEL BLAZER STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO EZEKIEL FROMEL 1300 N 20TH STAPTP3058 RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 969004561IN STOP 5
VE"'LE ❑ Nu
J
,J� CITATION# CHARGE
25 io BOTTOM
L LLY YESEGA s � a
7CA
OQ
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. EE54010
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1622
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 URE OF INJURIES
NAT
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On February 14, 2024, at 0905 hours dispatch requested that I respond to a collision at Miller Paint,
350 Sunset Blvd N, in the city of Renton, county of king, and state of Washington. Dispatch advised
that both vehicles were in the parking lot waiting for police assistance.
Upon contact I spoke with the driver of unit 1 and they explained they were attempting to cross the
northbound lanes to go southbound on Sunset Blvd N when the collision occurred. There was heavy
traffic going northbound and the only available lanes were lane 2 and lane 3. Traffic was heavy going
northbound so vehicles in lane 2 created a gap for unit 1 to cross. Unit one proceeded through the
lanes but failed to notice unit 2 going northbound in lane 3. When unit 1 entered lane, unit 2 was
unable to stop, hitting unit 1's driver's side doors.
I then spoke with the driver of unit 2 and they explained they were going northbound on Sunset Blvd
N when the collision occurred. The driver of unit 2 explained traffic had slowed down and failed to
notice unit 1 crossing the lanes. Unit 2 was in the number 3 lane and was unable to bring his vehicle
to a stop, hitting unit 1.
An exchange of information was given to both drivers and both vehicles sustained moderate damage.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 02-14-24 11:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 2/26/2024 4:55:16 PM
BADGE OR ID# 1Y007 OR]#' ' WA0171300 TIME POLICE DISPATCHED 9:09 AM TIME POLICE ARRIVED 9:17 AM
PART I PAGE IT]OF 3�
REPORT NO.! EE54010 CASE# 24-1622 DATE AND TIME 02/14/24 09:05
OF COLLISION
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