HomeMy WebLinkAbout24-3725 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-3725 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.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 RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. 04 - 1-- 2024 1700 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
120TH AVE SE BLOCK NO. e✓ 18800 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e SE 188TH ST
❑ �
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257534098 0 11
30
6� LAST NAME HUDSON FIRSTNAME ISABELLA MIDDLE M 1 2 31
INITIAL
STREET ❑ 16024 SE 180TH PL CITY RENTON ST WA ZIP 980589176 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ Pi aT�S� BCW3688 sTArI WAVrN# JTEEP21A370215706
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2007 TOYT HIGHLA UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO LINDSEY WILDS 11.1123RD LN SE AUBURN WA 98092 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 4319-82.31.44 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
15❑ STANDIN LEGALLvG YES❑NO❑ CITATION#
1 o BOTTOM
8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:4255298504
LAST NAME HARPER FIRST NAME AKIRA MIDDLE I D
INITIAL
17❑ STREET ❑', 12130 SE 186TH ST CITY' RENTON ST WA ZIP 980586622 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DRIVER'S STATE WA ]SEX IF D.C... 08 _ 24 1997 El
39
LICENSE# MMDDYY
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' A{RBAG,2 RESTR 4 EJECT '1 USE 2 CLASS 7 PRE
❑
21❑ LICENSE AJW3560 TAre I WA VIN# 3D4PG1FG56T500703
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE DODG MODEL JOURNEY STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO WARREN MCEACHERN 12130 SE 186TH ST RENTON WA 98058 VEHICLE NO.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO FARMERS 187876358IN STOP 5
VE""LE ❑ ,J CITATION# CHARGE to BOTTOM
LEGALLY YES Nu
25 ' a
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. EE71374
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3725
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ARMSTONG KAYANA
(LAST FIRST,
ADDRESS&PHONE# D O.B.
16642 160TH PL SE RENTON WA 98058 SEX U MMDDYyry 02 - 09 - 2006
PASSENGER Z WITNESS 'UNIT# 1 POS 'I 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET CLASS NATURE OF INJURIES
USE 2 CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 1500 hours I responded to a collision at SE 188th St and 120th Ave SE, in the
city of Renton. Upon my arrival I spoke with the driver of unit 2 who explained that she was driving
northbound on 120th Ave SE when unit 1 decided to run a stop sign, crossing in front of her. Unit 2
was unable to bring the vehicle to a complete stop, striking unit 1's rear passenger side bumper.
I then spoke with the driver unit 1 and she explained that she was waiting at the stop sign waiting to
cross eastbound on S 188th St. She failed to notice unit 2 driving northbound at the intersection so
she proceeded forward. As unit 1 proceeded forward, she was struck by unit 2 on her rear left bumper
and quarter panel.
The driver of unit 2 had complains of pain but refused to be transported to the hospital. She stated
she would visit the hospital after I concluded my investigation.
Both vehicles sustained moderate damage, and no vehicles needed to be towed away.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 04-25-24 11:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 4/25/2024 12:40:05 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 5:01 PM TIME POLICE ARRIVED',5:24 PM
PART I PAGE IT]OF 3�
REPORT NO. EE71374 CASE# ' 24-3725 DATE AND TIME 04/05/24 17:00
OF COLLISION
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