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HomeMy WebLinkAbout24-6291 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-6291 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AGENC 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 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# ❑ cawsloN 06 - 1-- 2024 1108 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S 36TH PL BLOCK NO. e✓ 900 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 100 00 FEET e S ❑ W e WELLS AVE S 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2069149138 0 11 30 6� LAST NAME SAMSON FIRSTNAME TIFFANY MIDDLE L 1 1 2 31 INITIAL STREET ❑, 3600 MILL AVE S CITY RENTON ST WA ZIP 980555887 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 aT�S� CFF2763 sTArI WAvIN# 7SAXCAE51NF357862 TRAILER STATE TRAILER STATE11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 2 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34 13 2 2022 TESL MODEL DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO WELLS FARGO PO BOX 997517 SACRAMENTO CA 95899 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 961631317 3 4 IN EFFECT &POLICY# 9TOP vErIICLE CHARGE 5 36 LEcn YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065126288 16 a LAST NAME PHILLIPS FIRST NAME ANGELA MIDDLE M INITIAL 17❑ STREET ❑', 1026 S 36TH PL CITY RENTON ST WA ZIP 980555881 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑No� INTERLOCK Y�EsI I I NOF YEs t l NO� 19 DRIVERS # STATE WA SEX F Mr D.O.B. 07 30 _ 1980 39 H USE ET LAU SY SORE FACE TASTE OF BLOOD IN MOUTH F—NATURE OF INJUR Es 40 20 ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 2 7 21❑ LICENSE I CKE5223 TAre I WA VIN# 5YJ3E1E69PF637186 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. N#. 43 RLR 'I VEH YEAR 2023 MAKE TESL MODEL MODELS STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO LINDA PHILLIPS 23306 SE 253RD PL MAPLE VALLEY HEIGHTS WA 98038 D:5122297804 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO USAA LINDA PHILLIPSIN STOP 5 'E""Le ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N`L J 25 ' a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 C.STEED 8770 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE86904 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6291 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) PHILLIPS LINDA K (LAST FIRST, ADDRESS&PHONE# D O.B. 23306 SE 253RD PL MAPLE VALLEY WA 98038 5122297804 SEX F MMDDYyry 08 - 02 - 1950 SEAT HELMET INJURY NATURE OF INJURIES PASSENGERWITNESS❑ UNIT# 2 POS. y AIRBAG:2 RESTR. 4 EJECT 1 USE 2 CLASS '7 SORELEFTRIBCAGE NAME (LAST,FIRST,MIDDLE INITIAL) FRAZON STEPHANIE ADDRESS&PHONE# Ly O 2044 24TH AVE S SEATTLE WA 98144 8162177743 SEX' F MMDDWvvv 12 _ 03 _ 1987 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER ZWITNESSO UNIT# 2 POS 3 AIRBAG'6 RESTR. 4 EJECT 1 USE 2 CLASS 7 SORE SHINS NAME (LAST FIRST,MIDDLE INITIAL) PHILLIPS JERRY B ADOREss PHONE# 23306 SE 253RD PL MAPLE VALLEY WA 98038 5126578754 SEX M D•O•B• 12 I. _ 01 _ 1946 MDDYYYY PASSENGER WITNESS UNIT# ! 2 SEAT 7 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 NJURY 7 NATURE OF INJURIES �. POS. USE :GLASS BLOODYNOSE NARRATIVE' On 06/15/24 at about 1117 hrs I arrived in the 900 block of S 36th PI for an injury collision, in the City of Renton, County of King, and State of Washington. The driver of unit#1 said the vehicle collision was her fault and she would take responsibility for it. Unit#1 had been driving EB on S 36th PL and Unit#2 had been driving WB. The driver of Unit#1 was driving EB partially in the WB lane when the collision occurred. Driver#2 was WB in the WB lane of S 36th PL just west of Wells Ave S. The collision happened on a curve. Unit#1 collided with the front end of Unit#2. Unit#2 was completely within the WB lane markers when the collision occurred. The driver of Unit#1 said she was not injured. The driver of Unit#2 said her face was sore from the airbag deployment and she could taste blood in her mouth. Unit#2 front seat passenger complained of shin pain due to the bottom airbags deploying. Unit#2 rear driver's side passenger was treated for a bloody nose. Unit#2 rear passenger side passenger complained the left side of her ribcage was sore. Everyone was seen by Renton Fire for treatment. Both vehicles were impounded by Banker's towing. This incident was captured on my body worn video camera. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. The video was uploaded to evidence.com. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically Signed by Officer Steed on 06/15/24 1245 hrs, Renton Washington Cassidy Steed/8770 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.STEED 06-15-24 12:51 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT D.SKELTON 9139 6/15/2024 2:08:11 PM BADGE OR ID# 8770 OR]# ! WA0171300 TIME POLICE DISPATCHED 11:09 AM TIME POLICE ARRIVED';11:17 AM PART I PAGE IT]OF 3� REPORT NO. EE86904 CASE# ' 24-6291 DATE AND TIME 06/15/24 11:08 OF COLLISION ti ! +S t t PAGE 3 OF 3