HomeMy WebLinkAbout24-1957 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 24-1957 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 02 - 1-- 2024 1530 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
L1ND AVE SW BLOCK NO. e✓ 3400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW 34TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2069460829 0 11
30
6� LAST NAME JOHNSON FIRSTNAME DENESIA MIDDLE R 1 1 2 31
INITIAL
STREET ❑, 2914 FOREST RIM CT S CITY PUYALLUP ST WA Zjp, 983741649 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CBN7886 sTArI WAvIN# 5GAKVCED9CJ162863
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. TRLR 7 3 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 2012 BUIC ENCLAV DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO DENESIA JOHNSON 2914 FOREST RIM CT S PUYALLUP WA 98374 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 29742 3 4
IN EFFECT &POLICY# Qi),
VE— CHARGE 36
LEGALLYYES❑NO CITATION#15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066507582
LAST NAME WATSON FIRST NAME ANTHONY MIDDLE IR
INITIAL
17❑ STREET ❑', 8710 5TH AVE W APT K339 CITY EVERETT ST WA ZIP 982042217 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19[—] DRIVER # STATE INA SEX M M D.O.B. 12 _ 28 _ 1981 El 39
HELMET {NJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE 2 CLASS HAND INJURY
21❑ LICENSE I CLR3501 TAre I WA VIN# 3(BNFK16307Co102908
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2007 MAKE CHEV MODEL SUBURB STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO�/ YES NO✓
REGISTERED OWNER INFO ANTHONY WATSON 87105TH AVE W APT K339 EVERETTWA98204 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N J
25 e
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE57078
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1957
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) COIN TRACEYL
(/AST FIRST,
ADDRESS&PHONE# D O.B. '
2712 ABERDEEN AVE NE RENTON WA 980562210 3609201831 SEXi F MMDDYyry 10 - 21 - 1971
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
L`�1 POS, USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# Ly O
SEX MMDDYVYV
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 22nd at 1530 hours I responded to a collision at the intersection of SW 34th St. and Lind
Ave. SW, in the city of Renton, county of king, and state of Washington.
Upon my arrival I spoke with the driver of unit 2 and they explained they were going southbound on
Lind Ave. SW in the number one lane when the collision occurred. The driver of unit 2 stated they
were approaching SW 34rd St. when unit 1 failed to come to a complete stop, running the stop sign.
Unit 1 was going eastbound at the intersection and crossed in front of unit 2. Unit 2 was unable to
bring his vehicle to a stop, striking unit 1's driver side door.
I then spoke with the driver of unit 1 and they explained they were stopped facing eastbound at the
intersection. They looked North and South from the intersection but did not see any vehicles on the
roadway. They proceeded through the intersection and were subsequently struck by unit 2.
Unit 1 stated they never saw unit 2.
Both vehicles were disabled and towed away.
Renton Fire checked the drivers for any medical injuries, but both returned clear.
An exchange of information was given to both drivers, and both vehicles were towed away by
bankers towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 02-28-24 06:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 31712024 3:54:22 PM
BADGE OR ID# 12007 OR]# WA0171300 TIME POLICE DISPATCHED; 3:32 PM TIME POLICE ARRIVED 3:38 PM
PART I PAGE IT]OF
REPORT NO. EE57078 CASE# ' 24-1957 DATE AND TIME 02/22/24 15:30
OF COLLISION
Text
NTS
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