HomeMy WebLinkAbout24-2930 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-2930 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 03 - 18 - 2024 0801 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NW 3RD PL BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 00 FMILES EET e S ❑ E e TAYLOR AVE NW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2068523839 1 4 30
6� LAST NAME SMITH FIRSTNAME SADARA MIDDLE H 1 1 2 31
INITIAL
STREET ❑ 365 TAYLOR AVE NW CITY RENTON ST WA 21p 98057 z=
NEW ADDRESS
❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
7
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 3 RESTR 2 . EJECT 1 H USE 2 CLASS 6 [NATURE OF INJURIES
HEAD/NECK FROM AIRBAG zLICENE1 ❑
3
10� P1 ATEB9t 8802MH STATE WA -#' 1Y1SK528X2Z409314
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12 0 0 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 3 34
13 2 2002 CHEV PRIZM/ SD DAMAGE vEs 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO WAYNE SMITH 365 TAYLOR AVE NW RENTON WA 98057 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ ABILI V INSURANCE INSURANCE CO PROGRESSIVE 915032394 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN.D'ING 7 6
UNIT VE IOOR Z CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES H SOLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX U MMDDYY 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG g RESTR 9 EJECT '1 USE 9 CLASS 0 ❑
❑21❑ 41
LICENSE I PLA E# C99911Y [TAT WA VIN# 1FTEF25N9MPA14304 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 1991 MAKE FORD MODEL F250 STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SAMUEL OWENS 114 NW3RD PL APTH RENTON WA 98057 D:7754439151 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04377-04-70-32IN 9TOP
—e E YES❑ N J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY
25 $ '
7JUS
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26KAUPPILA 12883 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE61617
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2930
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'
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.
JUSTIN KAUPPILA 03-18-24 11:17 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 312212024 5:58:49 PM
BADGE OR ID# 1Y883 OR]# WA0171300 TIME POLICE DISPATCHED 8:04 AM TIME POLICE ARRIVED]8:08 AM
PART I PAGE IT]OF 4�
REPORT NO. EE61617 CASE# 24-2930 OF COLLISION
03/18/24 08:01
OF CbLLI510N
NARRATIVE
24-2930
Unless otherwise noted, the following occurred within the city limits of Renton, county of King, state of
Washington.
On 03/18/2024, 1 was working as a uniformed police officer for the city of Renton. At approximately
0804 hours, I was dispatched to a motor vehicle collision with injury located at NW 3rd PI and Taylor
Ave NW. My involvement in the incident was captured on my department-issued Axon body-worn
camera.
While enroute to the location, dispatched relayed that two motor vehicles were involved in the
collision, with the reporting party stating injury, the reporting party was later identified as the driver of
unit 1.
When I arrived on scene, I spoke with the owner of unit 2, a Ford F250, who relayed the following:
They were not in the vehicle at the time of the collision. They noticed the collision from their
apartment across the street.
I contacted the driver of unit 1, a Chevrolet Prizm who relayed the following:
They were heading eastbound on NW 3rd PI. The sun created a glare and impaired their vision. The
vehicle then struck unit 2 from behind, which was parked facing east on NW 3rd Pl. The airbags
deployed.
Renton Regional Fire Authority arrived on scene and evaluated the driver of unit 1, and subsequently
cleared them of injury.
I completed an exchange of information for both involved parties, and gave each of them a copy of
my business card with the appropriate case number.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer J. Kauppila at 1008 hours on 03/18/2024.
PAGE 3 OF 4
REPORT NO. EE61617 CASE# 24-2930 DATE AND TIME 03/18/24 08:01
OF COLLISION
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