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HomeMy WebLinkAbout24-5796 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-5796 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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: 06 — 1—— 2024 1541 17 ❑. S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BURNETT AVE S BLOCK NO. e✓ 400 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e S 4TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO F,/ I D:2064782600 30 6 LAST NAME SPEIGHT FIRSTNAME THOMAS MIDDLE B 1 F 2 31 INITIAL STREET ❑, 95 BURNETT AVE S 316 CITY RENTON ST WA 2jp, 98057 z= NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MID -O B 09 - 14 - 1946 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 3 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 2❑ I P1 ATNES# BPT5423 sTAr WAv N# 2FMPK3K94J6645253 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR. 5 1 33 12❑ VIN#' VIN# FROM TO ❑ VEH.YEAR MAKE FORD MODEL EDGE STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34 13 1 DAMAGE YES NO YES[:] NO✓ REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO ALLSTATE 987 102 929 3 4 IN EFFECT &POLICY# 9TOP VE'CLE CHARGE 1 5 36 LEcnlly YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 6 MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:4258304270 16 a LAST NAME MILLER FIRST NAME JAMES MIDDLE S INITIAL 17❑ STREET ❑' 17213 NE 4TH PL CITY' BELLEVUE ST' WA ZIP 98008 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑NOR INTERLOCK YEs❑NOF YES❑NO❑ 19 DRIVE # STATE SEX M M .C.B. 02 _ 19 _ 1954 39 ON DUTY STATUS 1 AIRBAG RESTR EJECT 3 HELMET 9 INJURY 7 NATURE OF INJURIEs 40 USE CLASS RIGHT KNEE ❑21❑ LICENSE TArE VIN# 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE #E CO IN EFFECT &PO IGQ "'LE ❑ ,.I— CITATION# CHARGE LEGALLY YES N`LJ 25 s � e =TAMAIVENA AME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 4 4 12812 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE82820 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5796 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) SPEIGHT MAUDRYL (LAST FIRST, ADDRESS&PHONE# D O.B. ' 95 BURNETT AVE S 317 RENTON WA 98057 2064782600 SEXi F MMDDYyry 05 - 18 - 1947 PASSENGER Z WITNESS❑'UNIT# 1 PO5 1 3 AIRBAG 2 RESTR. 3 EJECT ? HELMET NATURE OF INJURIES USE CLASS i1 NAME (LAST,FIRST,MIDDLE INITIAL) BARNETT BRYAN ADDRESS&PHONE# D O B BELLEVUE 2069108678 SEX M MMDDYYYY T _ PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 1 was traveling on 400 Block Burnett Ave S, going northbound. It stated that two pedalcyclists were traveling in the same lane, which was the only lane. Unit 1 stated that one of the pedal cyclists made a right turn on S 4th St, and the second pedal cyclist went in front of his vehicle, causing him to stop. Unit 1 stated that he did not like the pedal cyclist; the pedal cyclist threw his bike on the floor and hit the front of his vehicle with his fist. Unit stated that he did not want to exchange insurance but that the pedal cyclist just wanted his insurance. Unit 1 said he offered to call the cops, but he did not want to exchange information, so he left the scene. The pedal cyclist was traveling in the same direction on Unit 1. He stated that Unit 1 was not patient and bumped his rear tire, causing his bike to fall and himself to fall. He stated there were no injuries to himself but just pain in his right knee. He also stated there was no damage to his bike. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. S/TIVENI TAMAIVENA 06-01-24 09:22 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 6/2/2024 5:17:20 PM BADGE OR ID# 12812 ORI# WA0171300 TIME POLICE DISPATCHED; 3:44 PM TIME POLICE ARRIVED;3:47 PM PART I PAGE 2�OF❑ REPORT NO. EE82820 CASE# 24-5796 DATE AND TIME 06/01/2415:41 OF COLLISION , n,z t 1 4 t vv t t, t .e PAGE 3 OF 3