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HomeMy WebLinkAbout24-6301 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-6301 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4150 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 7 28 TOTAL#OF OBJECT TRIBAL UNITS 02 STRUCK' TREE OR STUMP 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 1546 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ S 6TH ST BLOCK e✓ 600 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV a SMITHERS AVE S 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4255294672 0 11 30 6❑ LAST NAME ADAMS FIRSTNAME DONALD MIDDLE G 1 1 2 31 INITIAL STREET ❑ 609 WHITWORTH LN S CITY RENTON ST WA ZIP 98057 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/ 8❑ LICENSE# STATE Wq SEX'M M LOB 05 - 15 - 1980 1 2 32 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 9 EJECT 9 H ELM U EET 9 CLASS 7 NECKAREA[NATURE OF JURIEs z❑ 3 10 2❑ PI ATE 14 CDV7722 sTAT WAu N# JM16J225920558586 0 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# 2002 MAZD PROTE SDYES[:] ❑ FROM 34 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13 4 DAMAGE YES NO �I YES NO REGISTERED OWNER INFO DONALD ADAMS 609 WHlTWORTH LN S RENTON WA 98057 D:4255294672 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 1 36 LEGALLY YES NO❑ CITATION# 10 BOTTOM 15❑ STAIN,DIING 8 UNIT 02 vEHIMOTOCLE CYCLE ❑ PEDESTRIAN ❑ OWNFR PEDAL RTY ❑ DYES NO OLD MET PHONE 16 a LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY RENTON ST ZIP 4 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIICENS RIVEWS# STATE SEX U MMDDYY -❑_ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''9 USE 9 CLASS 0 ❑ ❑21❑ TATE 41 IN#LICENSE V 1 PLATE# 42 22❑ PIR I I TRAILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2003 MAKE pJ1$S MODEL S(fV STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO U U U RENTON VEHICLE NO.2 SHADEDAMAGED AREA 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 9TOP 5 VE"LE ❑ ,J� CITATION# CHARGE to BOTTOM LEGALLY YES N`L J 25 ' e =TAMAIVENA AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 12812 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE92587 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6301 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 that he was traveling on S 6th St going eastbound. He was crossing Smithers Ave S when Unit 2 struck the rear driver side of the vehicle. Unit 1 said that his vehicle did a 360 and he struck a tree. Unit 2 then drove northbound on Smithers Ave S. When I arrived, I noticed that Smithers Ave S had a stop sign in both directions. Observing the damages on Unit 1 vehicle, it seems that Unit 2 did not make a complete stop. Unit 1 stated that he had minor pain in his neck area but declined aid at the moment. I took photos of this incident and will be uploading them to evedeince.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 06-16-24 05:14 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY E DAT J.TRADER 4553 7/3/2024 11:52:49 PM BADGE OR ID# 12812 OR]# WA0171300 TIME POLICE DISPATCHED 3:56 PM TIME POLICE ARRIVED';4:10 PM PART I PAGE IT]OF 3� REPORT NO. EE92587 CASE# ' 24-6301 DATE AND TIME 06/15/24 15:46 OF COLLISION Unit 2 o J „ . s ' nn� ztalk �n� � 4,,i,�, vettin a � r PAGE 3 OF 3