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HomeMy WebLinkAbout24-5484 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-5484 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 7 2$ 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 - 23 - 2024 1803 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ LIND AVE SW BLOCK NO. e✓ 1100 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e SWGRADYWAY 0 1 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO ,/ D:2063342613 0 11 30 6❑ LAST NAME SUSEYI FIRSTNAME CLAUDIA MIDDLE M 1 2 31 INITIAL STREET ❑ 19851 140TH AVE SE CITY RENTON ST WA Zlp 98058 z= NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE WA SEX'F MID .O B 07 1- 10 - 1986 2 32 9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 9 H USE SS 9 CLASS 0 NATURE OF INJURIES z❑ 3 LICENSE 3022LW sTArI WAurN# JNRBS08W76X401959 10❑ PI ATE 14 0 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# IR.. ro TRLR. TRLR 7 3 33 12 0 VIN#' VIN# 2006 lNFI FX45 UT ❑ RO�34 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13❑ DAMAGE YES NO �I YES NO REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE INSURANCE CO GEICO 4517-44.54.19 3 IN EFFECT &POLICY# 9TOP VE— CHARGE 36 LEGALLv YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 7 UNIT U2 VEHIMOTCR PEDAL- PROPECL D E CYCLE ❑ PEDESTRIAN ❑ OWN RRTY ❑ YES NO OLD MET PHONE 16 a LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY RENTON ST ZIP 17❑ NEW ADDRESS ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YES❑NOR INTERLOCK YEs It I NOF YES t l NO❑ 19 LLIICENS # STATE SEX U MMDDYY -❑_ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑ ❑ ❑ 41 21 LICENSE TArE VIN1t U PLATE# 42 22❑ PILER LATE# STATE pLATE# STATE 23❑ TRLR 43 L VIN#. N'RRI #. TOWED BY GOV HI 44 VEH YEAR MAKE /1J/$$ MODEL SQL)-/Nj�Q STYLE $D DAMAGE TOWED NOO✓ BLIN YES NO 24❑ REGISTERED OWNER INFO UNKNOWN RENTON VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGQVE"LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 =TAMAIVENA AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 12812 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE80522 COLLISION REPORT III III III III III 111 1591972 CASE# 1 24-5484 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 NJURY 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' Unit 1 was in lane 1 traveling eastbound on SW Grady Way approaching Lind Ave SW. Unit 2 struck Unit 1 in the rear of Unit 1 vehicle. Unit 2 then left eastbound on SW Grady Way. I observed minimum damage on Unit 1. Unit 1 was not able to provide a valid license plate for Unit 2. Unit 1 is able to identify the driver of Unit 2. 1 certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. This report was electronically signed by Officer Si. Tamaivena #12812, May 23, 2024, at 2045 Renton, WA. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. SITIVENI TAMAIVENA 05-24-24 01:26 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT DESIRES SCOTT 10272 5/26/2024 9:46:12 AM BADGE OR ID# 1Y892 OR]# WA0171300 TIME POLICE DISPATCHED 6:06 PM TIME POLICE ARRIVED]6:09 PM PART Ei PAGE IT]OF REPORT NO. EE80522 CASE# ' 24-5484 DATE AND TIME 05/23/24 18:03 OF COLLISION q w � t. z t � A Y 44n, i t PAGE 3 OF 3