HomeMy WebLinkAbout24-3716 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-3716 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 1410 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N BLOCK NO. e✓ 737 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ V\e N 6TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2068194472 0 11
30
6� LAST NAME MACIEL FIRSTNAME JORDAN MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 24115 107TH PL W CITY EDMONDS ST WA ZIP 980205241 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 BZR0849 STATE WA VIN# 5YFS4MCE9MP091325
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2021 TOYT COROL DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ,LOSE MACIEL 24115107THPL W EDMONDS WA 98020 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 4509-20.67.20 3 4
IN EFFECT &POLICY# 9TOP
VE—LE 5 36
LEGALLY
res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ �,YTANG 8
MOTOR PEDAL- PEDESTRIAN
16 a PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:5094056723
LAST NAME GRIGSBY FIRST NAME PRISCILLA MIDDLE N
INITIAL
17❑ STREET ❑', 3125 NW COTTONWOOD LN APT 119 CITY PULLMAN ST WA ZIP 991633192 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 LDI IVER # STATE WA ]SEX IF M D.O.B. 11 24 2001 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CFY5776 TATe WA vIN# 1YVHZ8CH065M02500
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE ryMAZp MODEL 61 STYLE Sp VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DARION LITTLE 1582038TH PL S,APT 123 TUKWILAWA98188 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 968108819IN STOP 5
0(
VE"'LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N`L J
25 ' 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. EE69014
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3716
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'
On April 5, 2024, at 1147 hours dispatch requested that police respond to a collision west of N 6th St
and Logan Ave N, in the city of Renton.
Upon my arrival I spoke with the driver of unit 1 and he explained that while attempting to cross N 6th
St, he failed to notice unit 2. He had a stop sign, he waited, looked both ways crossed the intersection
without seeing unit 2. and was subsequently struck by unit 2 which was going eastbound on N 6th St.
I then spoke with the driver of unit 2 and she explained she was going eastbound on N 6th St when
unit 1 crossed right in front of her. She was unable to stop, striking unit 1's drivers side door.
An exchange of information was given to both drivers and unit 2 needed to be towed away by Gene
Meyers towing.
No one complained of any sustained injuries.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 04-05-24 04:56 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 4/16/2024 2:20:13 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 2:18 Pry] TIME POLICE ARRIVED',2:27 Pry]
PART I PAGE IT]OF 3�
REPORT NO. EE69014 CASE# ' 24-3716 DATE AND TIME 04/05/24 14:10
OF COLLISION
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