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HomeMy WebLinkAbout24-6508 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SAS 24-6508 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 06 - 1-- 2024 1809 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MEADOW AVE N BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 3RD ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2537098556 0 11
30
6� LAST NAME GARRETT FIRSTNAME MANUEL MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 4750 AUBURN WAY N APT Q101 CITY AUBURN ST WA 2jp, 98002 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CKX0523 sTATI WAurN# KL47LCE21RB027897
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 3 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 3 34
13 1 2024 BUIC ENVIST SD DAMAGE YES NO ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� LIABILITY INSURANCE� INSURANCE CO PROGRESSIVE 958092015 <1�3 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLv YEs❑NO CITATION# 4A0529620 INATTENTIVE DRIVINGorrom
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:3602232348
LAST NAME O'HARA FIRST NAME JAMES MIDDLE IC
INITIAL
17 STREET ITON AVE S CITY RENTON ST' WA ZIP 98118 4❑ 37
NEW ADOREs�' 9205 REN
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO INTERLOCK vEs I I NOF YEs t l NOF,/
19 LICENSE# STATE WA SEX M M .O.B. 05 _ 07 1974 39
F—NATURE OF INJURIES
20❑ ON DUTY STATUS AIRBAG 2 RESTR 1 EJECT 3 H EET 5 iN ASSY 6 FACIAL BLEEDING FLUNG OFF MOTORCYCLE ❑ 40
❑ILICENSE 21❑ PLATE# SG1792 TATE WA VIN11 JS1VY52A052107251 41
1
42
22❑ PLATILER E# STATE pLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
TOWED By Gov HI 44
VEH YEAR 2005 MAKE S(JNIC MODEL C90 STYLE MT DAMAGE TOWED NOO✓ BLIN YES
NO 1/
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#ECO AMERICAN FAMILY INSURANCE 410666975808 1UR
IN EFFECTVE."Le ❑ ,J� CITATION# CHARGELGALYES N
25 =TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE92051
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6508
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 2 was traveling east bound on N 3rd ST in the left most lane approaching the intersection of
Meadow Ave N and N 3rd ST. Unit 1 was stopped at a stop sign on Meadow Ave N facing northbound
attempting to make a right turn onto N 3rd ST to proceed eastbound. As Unit 2 was approaching the
above intersection Unit 1 pulled out in front of Unit 2. This caused Unit 2 to collide with the front of
bumper of Unit 1, launching the driver of Unit 2 off of his motorcycle.
Unit 2 had a minor cut on his chin as well as scrapes and bruises on his body. There may be further
injuries as he went to urgent care directly after the collision. Unit 1 reported no injuries.
Unit 2 had minor cosmetic damage to their motorcycle and the vehicle still appeared driveable. Unit 1
significant damage to the front bumper of the vehicle and was no longer driveable.
The proximate cause of the collision was Unit 1 failing to provide right of way to Unit 2, as he directly
turned into Unit 2s path of travel. Unit 1 was cited for Inattention for failure to pay attention to Unit 2's
path of travel.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 06-25-24 12:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 71212024 9:09:54 AM
BADGE OR ID# 12650 ORI# WA0171300 TIME POLICE DISPATCHED; 6:11 PM TIME POLICE ARRIVED',6:15 PM
PART Ei PAGE IT]OF
REPORT NO. EE92051 CASE# ' 24-6508 DATE AND TIME 06/20/24 18:09
OF COLLISION
s
ti
e,
PAGE 3 OF 3