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HomeMy WebLinkAbout24-6160 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 SAS 24-6160 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ vFFilC;l F ❑ LOCAL AGENC 3 HIT&RUN ✓ CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 1 7 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# ❑ C{YLLISION Os - 11 - 2024 1838 17 ❑. S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLOCK 307 RAINIER AVE S MILEPOST ST e✓ 300 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e 1 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO ✓ I D:7206768219 1 11 30 6❑ LAST NAME ANDERSON FIRSTNAME CAMERON MIDDLE / 1 31 INITIAL STREET ❑, TRANSIENT CITY RENTON ST WA ZIP' 98058 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO✓ INTERLOCKYEs NO✓ YES R No 8❑ LDRIVER # STATE CA SEX'M MM D Y' 10 1— 21 — 1975 1 2 32 9❑ ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 9 H USEET 9 INJ gY 0 NATURE OF INJURIES z❑ 3 LICENSE 3QJW398 STATE CA VIN# 1J4FJ28SXVL507190 10 9❑ Pr ATE� TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# IRM ro TRLR. TRLR m 33 12 0 0 VIN#' VIN#' 1997 JEEP CHERO UT ❑ RO�34 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 13❑ DAMAGE YES NO ✓ YES NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEHlcl.e CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 10 BOTTOM 15❑ STAIN,DIING 8 UNIT U2 VEHIMOTOCLE CYCLE ❑ PEDESTRIAN ❑ oWNFR PEDAL RTY ❑ DYES NO OLD MET PHONE 16 a LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL 17 1-1STREET CITY RENTON ST ZIP NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YES❑NOR INTERLOCK yEs❑NOF YES❑NO❑ 19 LLIICENS RIVERS# 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 ❑ 21❑ LICENSE A7202978 TATE WA VIN# 1(BNERFKW1KJ321596 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ TRLR R 43 LR VIN#. N I #. GI VEH YEAR 2019 MAKE CHEV MODEL TRAVERS STYLE UT DEHICLE AMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO✓ 44 24❑ ES REGISTERED OWNER INFO UNKNOWN RENTON VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5 VE"LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N`L J 25 s � e =TAMAIVENA AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12812 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF02474 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6160 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' Unit 1 stated he was parked at a parking spot at O'Reilly Auto Parts located at 307 Rainier Ave S. Unit 2 parked right beside his vehicle. While Unit 2 was trying to reverse out, the subject made contact with Unit 1 vehicle. The driver of Unit 1 was a younger male who he believed was 16 years old. Unit 2 then switched with an older male, who he believes is his dad, to reverse the vehicle out. I observed minor damage to the Unit 1 vehicle. unit 2 did not want to exchange information and left the scene. I uploaded the photos of the suspects and the vehicle license plate to evdeince.com. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. SITIVENI TAMAIVENA 07-31-24 09:19 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT P.SUMMERS 8887 81512024 2:22:03 PM BADGE OR ID# ! 12812 OR]# WA0171300 TIME POLICE DISPATCHED, 7:14 PM TIME POLICE ARRIVED;7:25 PM PART I PAGE IT]OF 3� REPORT NO. EF02474 CASE# 24-6160 DATE AND TIME 06/11/2418:38 OF COLLISION gico t i}4 i y yl t I 4 u E is r x, �qir Yje L S a,. t, i ' ', 3t z v�J,3 yN �• 2 �� k L"trak�..�.... Gar;ai � *�,.�s �..w ,¢kxi�. .��u; a i�a.�w *�4-?t ms",`% ac p"It Tom—,ta. PAGE 3 OF 3