HomeMy WebLinkAbout24-6106 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 24-slos 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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 RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
Ct ELISION' 06 - 10 - 2024 1731 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH STREET BLOCK NO. e✓ 3200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 179 00 FMILES EET e S ❑ W e MONROE AVE NE
0 4 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
,/No D:3145665065 0 11
30
6� LAST NAME STILLS FIRSTNAME CHARLISA MIDDLE M 1 1 2 31
INITIAL
STREET ❑✓ 12548 LAKE CITY WAY NE APT A301 CITY I SEATTLE ST WA ZIP, 981252400 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YES NOF,/ YES R NO
8❑ LRIIVER # STATE WA SEX'F MM DI,Y' 06 - 17 - 1986CENS 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 CLASS 1 1 -1 NATURE OF INJURIES z❑
3
10 1❑ PI ATES EGW7070 sTATe MO vN# 2GNAXUEV1M6120860
C....� TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
FTRL-R TRL 5 7 R 33
12 3 5 VIN#' vN#'
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 9 2021 CHEV EQU/NO SV DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
4
14 2 LIABILITY INSURANCE INSURANCE CO GEICO 614-276.7984
LI EFFECT I SUR N# TOPVE—LE CHARGE <1�3
OTTOM 5 36
LEGALLY YES NO CITATION# W24011638,W24011638 FAIL YIELD PRIVATE RD MOTOR
15❑ STANDING 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069548374
a
LAST NAME JACKSON FIRST NAME KELLY MIDDLE lK
INITIAL
17 STREET NEW ADDREs7 3601 NE 6TH PL CITY RENTON ST WA ZIP 98056 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 F] DRIVER'S STATE WA SEX M I D.O.B. 12 _ 07 1970 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CKV1007 TATE WA VIN# 41
JA4T5VA90PZ061647 1
42
22❑ PLATE# STATE PLATE ILER# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
TOWED BY Gov HI 44
VEH YEAR 2023 MAKE �lijJ'j-$ MODEL OUTLAN STYLE $V DAMAGE TOWED NOO✓ BLIN YES NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAGELLAREA
z Cdd
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 817-809-591IN 1 STOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE86205
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6106
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.
MATTHEW NUGENT 06-10-24 06:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 6/13/2024 7:23:55 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 5:32 PM TIME POLICE ARRIVED i 5:33 PM
PART I PAGE IT]OF 4�
REPORT NO. EE86205 CASE# 24-6106 OF COLLISION
06/10/24 17:31
OF CbLLI510N
NARRATIVE
24-6106
On 06/10/2024 at approximately 1732 hours, I was dispatched to a non-injury and blocking vehicle
collision in the 3200 block of NE 4th Street, within the City Limits of Renton, County of King, State of
Washington.
Upon my arrival, I confirmed there were no complaints of injury requiring immediate medical response
at the time of report. While on scene, I was able to collect each involved party's information and
independent summary of the events leading up to the collision.
The driver of Unit#1 stated she was the sole occupant of her vehicle and was attempting to exit a
private property parking lot, located in the 3200 block of NE 4th Street, on the south side of the
roadway. The driver of Unit#1 stated that she was intending to make a left turn out of the parking lot
with the intent to proceed westbound onto NE 4th Street following the turn. The driver of Unit#1 said
she believed all traffic on NE 4th Street was clear and therefore proceeded out into the roadway. As
Unit#1 pulled out into the roadway, Unit#1 was met by another vehicle - Unit#2. The driver of Unit
#1 stated that Unit#2 was traveling fast and that she was unable to avoid the collision after having
pulled out into the roadway. Both vehicles collided causing moderate damage to the front bumper of
Unit#1.
The driver of Unit#2 said she was the sole occupant of her vehicle and was traveling eastbound in
about the 3200 block of NE 4th Street approaching the intersection of Monroe Ave NE in lane 3 of 3
(Left-Turn Lane). The driver of Unit#2 stated that while traveling eastbound, Unit#1 turned into her
vehicle from the south side of the roadway. The driver of Unit#2 stated she was unable to avoid the
collision and that both vehicles subsequently collided in the roadway causing moderate damage to
the front and rear passenger door of Unit#2.
Based on the above statements, 1 believe that the driver of Unit#1 (Stills) was the predominant factor
for the cause of collision as Stills is required to comply with RCW 46.61.205(1) which states that
every driver of a vehicle about to enter or cross a highway from a private road or driveway shall yield
the right-of-way to all vehicles lawfully approaching on said highway. Unit#2 was already underway
in the roadway and had right of way.
I issued the driver of Unit#1 (Stills) a correction notice for failure to comply with RCW 46.61.205(1)
and for Expired Registration greater than two months.
Both vehicles were able to be driven away without further incident. An exchange of information was
provided to all involved parties.
I certify (or declare) under penalty of perjury under the Law of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 6:55 PM 6/10/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EE86205 CASE# ' 24-6106 DATE AND TIME 06/10/24 17:31
OF COLLISION
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PAGE 4 OF 4
