HomeMy WebLinkAbout24-4490 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-4490 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 1039 17 ❑-= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
1405 BLOCK NO. e✓ 4400 ❑
4a MILEPOST
1❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 44TH ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ D:2063498050 0 9 30
6� LAST NAME KIM FIRSTNAME DEBORAH MIDDLE U 1 1 2 31
INITIAL
STREET ❑ 4035 91 ST AVE SE C{Ty MERCER ISLAND ST WA 2jp, 980404103 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 USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 5❑ PI ATE 14 BHX6290 STATE WA VIN#' JTJBARBZXF2041297
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 1 3 33
12 VIN#' VIN#
ROM TO
VEH.YEAR 2015 MAKE LEXS MODEL NX STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO DEBORAH KIM403591STAVE SE MERCER ISLAND WA 98040 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAFECO H2391123 3 4
IN EFFECT &POLICY# 9TOP
LVEHla.e 5 36
LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES, No D:2069094431
16 2
LAST NAME NANCE FIRST NAME MARY MIDDLE I E
INITIAL
17❑ STREET ❑', 5000 LAKE WASHINGTON BLVD NE A202 CITY RENTON ST WA ZIP 980565038 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.B. 01 07 1965 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS' A{RBAG,4 RESTR 2 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE CDE1016 TATe 41
WA YIN# 4S3GTA86XM3713604
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE SUBA MODEL ►MPREZA STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YESfj
NO,� YES NO
REGISTERED OWNER INFO EAN HOLDINGS LLC 14002 E 21ST ST TULSA OK 74134 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 352 6035-DO5-47FIN 1 VE""LE CITATION# CHARGELEGALL25 GQ
Y YES Nu
❑ J s e
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE79110
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4490
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 25, 2024, at 1039 hours dispatch requested that I respond to a collision that occurred at the
intersection of 1405 and NE 44th St, in the City of Renton.
Upon my arrival I spoke with the driver of unit 2 and she explained she was facing westbound on NE
44th St, waiting to make a left turn onto N 1405. Unit 1 had just driven down the offramp from 1405 and
was attempting to make a left turn to NE 44th St, to go eastbound. Unit 1 failed to see unit 2 at the
intersection, so she made a left turn and struck unit 2's right passenger doors.
I then spoke with the driver of unit 1 and she explained she was attempting to go eastbound on NE
44th St from the northbound off ramp of 1405. She failed to see unit 2 stopped in the intersection as
she made her left turn. She struck unit 2's passenger doors.
Unit 1 sustained minor damage, but unit 2's vehicle was its side airbags deploy.
Both drivers did not complain of any injuries and neither of the two vehicles needed to be towed
away.
I provided both drivers with an exchange of information and my contact information.
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 01:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 512012024 9:34:19 AM
BADGE OR ID# 1Y007 OR]#' ' WA0171300 TIME POLICE DISPATCHED 10:41 AM TIME POLICE ARRIVED]10:55 AM
PART I PAGE IT]OF 3�
REPORT NO.! EE79110 CASE# ' 24-4490 DATE AND TIME 04/25/24 10:39
OF COLLISION
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