HomeMy WebLinkAbout24-3430 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 24-3430 z
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# ❑
cowsloN 03 - 1-- 2024 1553 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD N BLOCK NO. e✓ 404
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 $ 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:5096375363 0 11
30
6� LAST NAME BOND FIRSTNAME KASEY MIDDLE J 1 2 31
INITIAL
STREET ❑ 2404 ALLEN ST APT A201 CITY KELSO ST WA 2jp, 986265354 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� Pi aT�S� CKN7604 sTATe WA urN# 3FA6POHDXHR131838
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IRM ro
TRLR. TPIL F1 1 1 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 2017 FORD FUSION SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO KART LOCKE I..NE 116TH ST VANCOUVER WA 98682 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATEFARM 529 1094-E13.47 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
LEGALLY
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4252096660
16 a
LAST NAME DIAZ FIRST NAME SHANNON MIDDLE M
INITIAL
17❑ STREET ❑', 17740 151 ST AVE SE APT 4R CITY RENTON ST WA ZIP 980589080 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.O.B. 08 _ 18 _ 1977 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 I CCV9965 TATe I WA VIN# 1N46L4FV2LC139596
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2020 MAKE pJ/$$ MODEL SQL)-/Nj�Q STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 3973179-F22-47CIN STOP 5
VE""LE ❑ Nu,J CITATION# CHARGE to BOTTOM
25
LEGALLY YES ' e
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. EE65045
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3430
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NASH MADISON J
(LAST FIRST,
ADDRESS&PHONE#
12223 NE 116TH ST VANCOUVER WA 986822040 SEXi F MMDDYyry 07 - 30 - 2001
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑, 1 POS. 3 2 4 1 USE 2 CLASS '1
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYVYV
PASSENGER ❑WITNESS❑ UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On March 29, 2024, at 1553 hours dispatch requested that I respond to a collision that occurred at
404 Sunset Blvd N, 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 she was going southbound and
exiting the Houser Way bypass tunnel, when unit 1 made an improper U-turn. Unit 2 was in the
number 3 lane and unit 2 was in the number 2 lane, both going southbound. Unit 1 made a U-turn
from the number 2 lane, causing unit 2 to strike their driver's side door.
I then spoke with the driver of unit 1 and they explained a similar story. They stated they made a U-
turn from the number 2 lane. The driver stated they did not see unit 2.
Both vehicles sustained moderate damage, but unit 2 needed to be towed away.
An exchange of information was given to both drivers.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 03-29-24 06:16 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 1 4/3/2024 5:46:04 PM
BADGE OR ID# 12007 ORI# WA0171300 TIME POLICE DISPATCHED; 4:36 PM TIME POLICE ARRIVED 4:58 PM
PART I PAGE IT]OF 3�
REPORT NO. EE65045 CASE# ' 24-3430 DATE AND TIME 03/29/24 15:53
OF COLLISION
s
t
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