HomeMy WebLinkAbout24-5838 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-5838 2
INTERSTATE ❑ CITY STREET FIRE R�RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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'. 06 - 1-- 2024 2035 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD N BLOCK NO. e✓ ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e I405
0 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252736493 0 11
30
6❑ LAST NAME GAITHER FIRSTNAME ANGELA MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 14007 SE 156TH CT CITY RENTON ST WA Zjp, 980587815 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 11 1- O6 - 1998 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H U SE CLASS 7 1 HAND FELT TINGLY z❑
3
,OF
P1 ATNES# BVM3455 sTAT WAu N# 1 FMYU93115KA61669
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 5 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR ZOOS MAKE FORD MODEL ESCAPE STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 5 34
13❑ DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCECO STATE FARM 540761IR1247 3 4
IN EFFECT &POLICY# 9TOP
vEEGALLYrIICLE YES CHARGE 5 36
L ❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YEs NO 1/ D:4252766493
16 a
LAST NAME HORAN FIRST NAME PEYTON MIDDLE N
INITIAL
17❑ STREET ❑', 15041 133RD AVE SE CITY RENTON ST WA ZIP 980582860 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.Q.B. 09 _ 17 2007 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CFJ3820 TATe WA VIN1t 1FAHP3FNXAW223072
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE FORD MODEL FOCUS STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO STEPHANIE PHILIO 2808 S 376TH PL FEDERAL WAY WA 98003 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 5464188CI843AIN 1UR
VEHICLE ❑ ,.II CITATION# CHARGELEGALLY YES N25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
N.ODALOV/C 11628 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE82907
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5838
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'
U1 was traveling northbound on Sunset Blvd N and proceeded to make a u-turn at Houser Bypass,
just under 1405 to travel southbound on Sunset Blvd N. U1 stated that U2 was traveling straight
southbound on Sunset Blvd N and was traveling as a fast rate. U1 continued to u-turn and struck U2
failing to yield to U2. 1.11's right front axel was damaged and was towed by Gene Meyer Towing.
Renton Fire Authority was first on scene and evaluated the driver of U1 as she stated she had hand
pain. U2 was drivable and had no injuries. No witnesses came forward.
Both drivers were provided with the case number. Ofc Rivera 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 06-03-24 01:26 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
E.EDMUNDS 12576 1 6/3/2024 2:08:04 AM
BADGE OR ID# ( 11628 OR]# ': WA0171300 TIME POLICE DISPATCHED! 8:35 PM TIME POLICE ARRIVED 8:39 PM
PART I PAGE IT]OF 3�
REPORT NO. EE82907 CASE# 24-5838 DATE AND TIME 06/02/24 20:35
OF COLLISION
not to scale
a°
a
0
v
1
t
c
c '
PAGE 3 OF 3
