HomeMy WebLinkAbout24-4329 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 24-4329 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4100 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#
COLLISION 04 - 1-- 2024 1907 17 ❑.❑ S 8 W e IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e TAYLOR AVE NW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2537377785 0 4 30
6❑ LAST NAME MELLOTT-PORTER FIRSTNAME JORDAN MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 7654 SW 32ND AVE#410 CITY PORTLAND ST OR 2jp, 97219 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE OR SEX'F MID
.O B 07 1- 31 - 1997 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELM
USEET I IINLJA
URY 1 [!!RE OF INJURIES z❑
3
LICENSE CLN2766 STATE WA VIN# JHLRE487X7C065063
10 1❑ PI ATE�
TRAILER STATE TRAILED STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>;. FROM TO
VEH.YEAR ZOO7 MAKE HOND MODEL CRV STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 7 34
13❑ DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO MUTUAL OF ENUMCLAW AB25075231 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
1/ No D:2065664493
16 a
LAST NAME GEBRESELASSIE FIRST NAME NAZARETH MIDDLE G
INITIAL
17❑ STREET ❑', 12604 78TH AVE S CITY SEATTLE ST' WA ZIP 98178 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK yEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 01 07 1973 39
LICENSE# MMDDYY
W USE
EET LASSY REDNESS TO TO COLLARBONE ❑NJURIES 40
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 6
21❑ LICENSE A7205131 TATe WA VIN1i JTMD6RFV3RJ051040
❑ 41
PLATE#
42
22❑ PLATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
Gov HI
VEH YEAR 2024 MAKE 7'Dy7- MODEL RA V4 D
STYLE UT AMAGE TOWED✓ TOO BLIN TOWED BY 44
YES
NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO GEICO 6158-87-48-56IN I STOP 5
VEHICLE YES[:] N
C[:] CITATION# CHARGE i o BOTTOM
LEGALLY
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
N.ODALOV/C 11628 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE69969
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4329
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BEVILACQUA AMAN
(LAST FIRST,
ADDRESS&PHONE# D.0.B.
2020 S 360TH ST#0101 FEDERAL WAY WA 98003 SEX M MMDDYYYY 12 - 17 - 1997
PASSENGER I�I WITNESS UNIT# j 1 SQL 3 AIRBAG 3 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE OF INJURIES
L�!1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) MURIGA TIGIST A
ADDRESS&PHONE# C.O.B.
12604 78TH AVE S SEA TTLE WA 98178 2065039745 SEX' F MMDDYYYY 10 _ 25 _ 1989
SEAT HELMET I INJURY NATURE of INJURIES
PASSENGER �WITNESS UNIT# 2 PGS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
U1 was traveling eastbound crossing Taylor Ave NW on Renton Ave S. The driver of U1 stated she
did not notice that she had a red light to come to a stop. U1 collided into U2 who was traveling west to
north taking a left turn and had the right of way. U1 sustained significant front-end damage and was
not drivable. U1 airbags were deployed. U2 sustained damage to the rear driver side and was not
drivable. U2 airbags did not deploy. The driver and passenger of U1 denied injury. The driver of U2
complained of collarbone pain and was evaluated by Renton Fire Authority (RFA) on scene. The
passenger of U2 is pregnant and was also evaluated by RFA. Both units were towed by Bankers
Towing. Both drivers were provided with the case number. I took photos of the scene which were later
uploaded to evidence.com. During this incident I was equipped with body-worn camera which records
both audio and video. Portions of the incident were recorded. This report is merely a summary of the
incident and is not intended to be an exact transcription of the entire investigation or what may have
been captured with the recording system.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
N.ODALOV/C 04-21-24 01:00 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 1128E 1 412112024 1:53:20 AM
BADGE OR ID# 111628 OR]# WA0171300 TIME POLICE DISPATCHED; 7:07 PM TIME POLICE ARRIVED'7:07 PM
PART I PAGE IT]OF 3�
REPORT NO. EE69969 CASE# ' 24-4329 DATE AND TIME 04/20/24 19:07
OF COLLISION
NOT TO SCALE Ul = Gray
_ ,,
PAGE 3 OF 3