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HomeMy WebLinkAbout24-4751 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE73873 170 27 COLLISION REP FIT 1591971 CASE 24-4751 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 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# ❑ cawsloN 05 - 1-- 2024 0514 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❑ 150 00 FMILES EET e S ❑ W e SUNSET BLVD N 2 0 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2069141430 0 11 30 6❑ LAST NAME SAILING FIRSTNAME JOHN MIDDLE D 1 1 2 31 INITIAL STREET ❑, 29974 220TH AVE SE CITY COVINGTON ST WA ZIP, 98042 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID LOB 11 1— 10 — 2004 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 CT CLF9252 sTArI WAvIN# 2G1W65E30G1120201 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# ROM ro TRLR. TRLR 3 7 33 12 3 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34 13 2016 CHEV IMPALA 4D DAMAGE YES NO YES[:] NO✓ REGISTERED OWNER INFO 1.SAILING 11174220THAVE SE COVINGTON WA 98042 D:2069141430 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14� LIABILITY INSURANCE INSURANCE CO STATE FARM 5434037-813.47 3 4 IN EFFECT &POLICY# 9TOP ve'CLE CHARGE 5 36 LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2068197548 16 a LAST NAME PETERSEN FIRST NAME KEVIN MIDDLE A INITIAL 17❑ STREET ❑' 29438 216TH AVE SE CITY' BLACK DIAMOND ST' WA ZIP 98010 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 LDIIVER # STATE WA SEX M M .C.B. 10 _ 14 1974 0 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CGH4171 TAre WA VIN# 1HGEM21543L045317 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2003 MAKE HOND MODEL CIVIC STYLE CID VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO KEVIN PETERSEN 29438216TH AVE SE BLACK DIAMOND WA 98010 D:2068197548 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU&PORGY#E CO ALL STATE 820 349 520IN 1 VE—LE ❑ ,J� CITATION# CHARGE 25 GQI LEGALLY YES N`L J s � a =AS NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 SWAN 7 12965 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE73873 COLLISION REPORT III III III III III 111 1591972 CASE# 24-4751 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. NICHOLAS SWAN 05-03-24 07:04 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 51412024 6:42:49 AM BADGE OR ID# 12965 OR]# ! WA0171300 TIME POLICE DISPATCHED 5:18 AM TIME POLICE ARRIVED',5:23 AM PART I PAGE IT]OF 4� REPORT NO. EE73873 CASE# 24-4751 OF COLLISION 05/03/24 05:14 OF CbLLI510N NARRATIVE On 05/03/2024 at approximately 0518 hours, I was dispatched to a non-injury and non-blocking two- vehicle collision at the intersection of N 3rd St and Sunset Blvd N, within the city limits of Renton, county of King, state of Washington. Upon arrival, I contacted the involved parties and confirmed no injuries had occurred requiring immediate medical response at the time of report. There, I collected the involved parties driving documents and their independent recollection of events leading up to the collision. The driver of Unit#1 said he was traveling northbound on Sunset Blvd N in the left-hand turn lane waiting to turn on to N 3rd St. The driver of Unit#1 stated he turned in to the center lane of N 3rd St and then turned into the left-hand lane when the driver of Unit#2 collided with his driver side passenger and driver doors causing moderate damage. The driver of Unit#2 said he was the sole occupant of his vehicle and also traveling northbound on Sunset Blvd N in the left-hand turn lane and waiting to turn on to N 3rd St. The driver of Unit#2 stated he was in the left lane of N 3rd St after the light turned green when Unit#1 turned left in front of him hitting his passenger side front quarter panel. I viewed dash camera video from the driver of Unit#1 on scene. The video provided confirmed the stories from both parties. Based on the above statements, 1 determined that the Driver of Unit#1 (John) was the predominant factor for the collision due to inattention causing a collision. John should have been paying closer attention to the vehicles around him. Unit#1 was able to be driven away without further incident. Unit#2 also drove away without further incident. No citation was given to either party. An exchange of information was provided to all involved parties. I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer N. Swan #12965 0607 hours on 05/03/2024 in Renton, King County, WA. PAGE 3 OF 4 REPORT NO. EE73873 CASE# 24-4751 DATE AND TIME 05/03/24 05:14 OF COLLISION s b \ l r to a PAGE 4 OF 4