HomeMy WebLinkAbout24-2007 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
SASE 24-2007 2
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 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 - 1-— 2024 2017 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 7 ST BLOCK e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e RAINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2065367005 0 81
30
6� LAST NAME GILL FIRSTNAME MICHAEL MIDDLE J 1 2 31
INITIAL
STREET ❑ 23508 60TH AVE S APT N201 CITY KENT ST WA Zjp, 980323790 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ P1 ATE 14 CDt 3211 BTAT WA u N# 2HGFG12646H501623
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM ro
TRLR. TRLR 3 7 33
12 0 0 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2006 HOND CIVIC 2D DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO MICHAEL GILL 2350860THAVE S APTN201 KENTWA98032 D:2065367005 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO <53 4
LIABILITY INSURANCEIN EFFECT &POLICV# TOPVEHICLe CHARGE OTTOM 5 36
LEGALLY YES NO CITATION# 4A0001168,4A0001168 OP MOT VEH W/OUT INSURANCE,
15❑ STANDING 6
UNIT MOTOR PEDAL- ❑ PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLD MET PHONE
1 VEHICLE CYCLE OWNER YES NO �/
16 a
LAST NAME CHASE FIRSTNAME HOLLY MIDDLE I L
INITIAL
17❑ STREET ❑', 18655 8TH AVE SW CITY NORMANDY PARK ST WA ZIP 981663865 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYEs❑No� INTERLOCK ves No� YES
NDF]
19[-] DRIVER #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I BRW2514 TATe WA VIN1t JM3KFBEY9K0632426
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE MAZp MODEL CX-5 STYLE VT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HOLLY CHASE 186558TH AVE SW NORMANDY PARK WA 98166 D:2067076580 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO PROGRESSIVE 943163034IN 1 9TOP 5
'EwCLE CITATION# CHARGE
LEGAL
25 i o BOTTOM
LY YES N(�
❑ s
7CPAGE
ER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
T 8660 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE53525
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2007
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STORBAKKEN ROLLIE G
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
18655 8TH AVE SW NORMANDY PARK WA 981663865 2069309937 SEX M MMDOYyry 08 - 19 - 1954
PASSENGER I�I WITNESS UNIT# 2 POS. 3 AIRBAG 2 RESTR. 4 EJECT ? 1 H USE 2 CLASS !1 NATURE of INJURIES
NAME L�1
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.PAGET 02-24-24 06:43 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 2/24/2024 7:48:24 PM
BADGE OR ID# 8660 ORI# WA0171300 TIME POLICE DISPATCHED{ 8:99 PM TIME POLICE ARRIVED',8:22 Pm
PART I PAGE IT]OF 4]
REPORT NO. EE53525 CASE# 24-2007 OF COLLISION
02/23/24 20:17
OF CbLLI510N
NARRATIVE
24-2007 Non-injury collision
Axon:
Axon body cam available
Narrative:
On 02.23.2024 at 2022 hours, I arrived on a collision which occurred at 2017 hours in the intersection
of S 7 ST and Rainier AVE S. This is within the city limits of Renton, County of King, WA. Both
vehicles pulled into 201 S 7 ST prior to my arrival.
When I arrived, I spoke with Michael J Gill Jr. DOB/01.21.1983. Gill Jr was advised that our contact
was recorded. Gill Jr was identified by photo WADL and has a DOL status of licensed. Gill Jr. told me
that he was driving the gray 2006 Honda Civic CP WA/CDL3211. This is registered and legally owned
by Gill Jr. This vehicle is expired 07.19.2023. Gill Jr didn't have his registration or insurance
because they recently were stolen from his vehicle during a vehicle prowl. Gill told me that he was
headed west on S 7th ST approaching the light where the white 2019 Mazda Cx-5 WA/BRW2514
driven by Holly Chase was stopped for the light. Gill Jr dropped his cell phone by his feet. By the time
he looked up, he had hit Chase's vehicle. The driver's airbag on Gill Jr's vehicle and Renton Fire was
called for precautionary reasons.
I spoke to Holly L Chase DOB/05.12.1962. Chase was advised that our contact was recorded.
Chase was identified by photo WADL and her DOL status is licensed. Chase provided her
registration and insurance. Chase was driving a white 2019 Mazda CX-5 WA/BRW2514. This is
registered and legally owned by Chase. Neither Chase nor her passenger Rollie G Storbakken
DOB/08.19.1954 were injured. Chase told me that she was on S 7 ST facing westbound in the left
turn lane to turn south on Rainier AVE S, when her car was struck from behind by Gill Jr in his Honda.
Gill emailed me an expired proof of insurance. 1 have emailed, texted him and left him a voicemail
asking for a current proof of insurance. It has not been sent.
I issued Gill a Sector infraction #4A0001168 for operating a motor vehicle without liability insurance
and following too closely. Request that the infraction be mailed by the court. No citation issued for
the expired vehicle license.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Paget/8660 6:40 PM 2/24/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EE53525 CASE# 24-2007 DATE AND TIME 02/23/24 20:17
OF COLLISION
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PAGE 4 OF 4