HomeMy WebLinkAbout24-3681 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-3681 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 3 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.. 04 - 1-— 2024 1615 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 3RD ST BLOCK NO. e✓ 1600 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a SUNSET BLVD N
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:2538862562 0 4 30
6 LAST NAME HYDE-SMITH FIRSTNAME TY MIDDLE M 1 2 31
INITIAL
STREET ❑✓ 3707 NE 6TH PL CITY RENTON ST WA ZIP 98056 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 2 RESTR 9 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ P1ATE14 CBV9797 STATE WA uN#' 1GNDT13W6X2226208
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 1 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 4 1999 CHEV BLAZER SV DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# STOP
Ela.e CHARGE 10BOTTOM 5 36
LvECALHLv res❑NO❑ CITATION# 5
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UN�T 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs NO 1/ D:2134583656
16 a
LAST NAME OH FIRST NAME JOON MIDDLE I S
INITIAL
17 STREET❑ NEW ADDREss❑' 1064 KIRKLAND AVE NE APT 207 CITY RENTON ST WA ZIP 980563458 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 08 _ 17 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# A7175809 TATE 41
WA VIN# KMHLL4DG3RU743501 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. 'IN#.
TOWED eY G.. HI 44
VEH YEAR 2024 MAKE yy�N MODEL ELANTRA STYLE $D DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO ALLSTATE 820711231IN 1G'E""LE
TOP
❑ ,J� CITATION# CHARGE OTTOM
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE65892
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3681
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
PM 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.
C.ARNOLD 04-04-24 05:14 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 4/6/2024 4:24:11 PM
BADGE OR ID# ! 12509 OR]# WA0171300 TIME POLICE DISPATCHED; 4:29 Pry TIME POLICE ARRIVED',4:26 PM
PART I PAGE IT]OF 4�
REPORT NO. EE65892 CASE# 24-3681 OF COLLISION
04/04/24 16:15
OF CbLLI510N
NARRATIVE
On 04/04/2024 at 1621 hours I was dispatched to a non-injury collision at the intersection of N 3rd St
and Sunset Blvd N.
Unit 1's driver stated that he was traveling East on N 3rd St behind Unit 2 approaching Sunset Blvd N,
preparing to turn left to proceed North on Sunset Blvd N in the number 3 lane.
Unit 2's driver stated that he was traveling East on N 3rd St in front of Unit 1 approaching Sunset Blvd
N, preparing to turn left to proceed North on Sunset Blvd N in the number 3 lane.
Unit 1 stated that while turning left onto Sunset Blvd N, Unit 2 began braking as an ambulance was
nearing the intersection and activated its emergency sirens. Unit 1's driver stated that he looked to
see the ambulance and did not see Unit 2 brake. Unit 1's driver stated that he looked forward and
was unable to stop in time. At this time, Unit 1's front bumper made contact with Unit 2's rear bumper.
Unit 2 stated that while turning left onto Sunset Blvd N, he heard the emergency sirens and began to
brake as he was unsure initially where the ambulance was at. Unit 2's driver stated that when he did
this, Unit 1's front bumper made contact with Unit 2's rear bumper.
There were no injuries in the collision.
Both vehicles remained operable and were able to be driven away from the scene.
I provided the drivers an exchange of information form for the incident.
This report is to document the circumstances of the collision.
PAGE 3 OF 4
REPORT NO. EE65892 CASE# ' 24-3681 DATE AND TIME 04/04/24 16:15
OF COLLISION
9 TO S C
r
PAGE 4 OF 4