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HomeMy WebLinkAbout24-6650 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 INTERSTATE ❑ CITY STREET FIRE ❑ CASE 24-ssso 2 RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 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# CtLLISION' 06 - 1-- 2024 1745 17 ❑-= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ N 4 ST BLOCK NO. e ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e PARKAVEN 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4252283565 0 11 30 6❑ LAST NAME ROEHL FIRSTNAME VIRGINIA MIDDLE E 1 2 31 INITIAL STREET ❑ 7963 139TH AVE SE CITY NEWCASTLE ST WA 2jp, 98059 z 'NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'F MID .O B 03 1— 11 — 1946 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ P1 aT�S� 87220X sTATI WAurN# JTDBE32K630155523 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FR.. ro TRLR. TRLR. 3 5 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 ] 34 13 1 2003 TOYT CAMRY SD DAMAGE YES NO YES❑ NO REGISTERED.WNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO ALLSTATE 007551970 3 4 IN EFFECT &POLICY# 9TOP LEwcL I CHARGE 1 5 36 LECAIIv YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 16 UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:2064884385 a LAST NAME KNIGHT FIRST NAME DRAKE MIDDLE A INITIAL 17 STREET NEW ADDREs�' 1315 REDMOND PL NE CITY RENTON ST WA ZIP 98056 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑NO� INTERLOCK yEs It I NOF YES t l NOF,/ 19 LDI IVEW # STATE WA SEX M M .C... 12 _ 24 1980 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ILICENSE 21❑ PLA E# BSE1271 TATE 41 WA VIN# STDYZ3DCSLS059278 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. N#. 43 RLR 'I I VEH YEAR 2020 MAKE 7'Dy7' MODEL SIENNA STYLE VN DAMAGE TOWED NOO✓ BLIN TOWED BY Gov HyES NO 1/ 44 24❑ YES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DA GEbAREA z Cdd LIABILITY INSURANCE &POINSURGY#E CO NATION WIDE 7296J951656IN I STOP 5 VE."LE ES❑ N J ,J� CITATION# CHARGE i o BOTTOM LEGALLY Y 25 s � e 7BRYAN NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26GROZAV 12489 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE92202 COLLISION REPORT III III III III III 111 1591972 CASE# 24-6650 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' Both unit one and two were driving west on North 4th St within the City of Renton, King County, Washington. North 4th St is a one easy west bound directional streett. Unit one attempted to make a left turn to head north on Park Ave North. Unit two was in the left lane next and was struck by unit one. There were no injuries reported and both vehicles were drivable. Unit one sustained damage to the front bumper and unit two sustained damage to the right rear side. I provided both parties a SECTOR exchange of information. Both have valid licenses and vehicle insurance. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BRYAN GROZAV 06-23-24 10:45 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 888 1 71212024 4:46:42 PM BADGE OR ID# ! 12489 ORI# WA0171300 TIME POLICE DISPATCHED 5:47 PM TIME POLICE ARRIVED',6:05 PM PART I PAGE IT]OF 3� REPORT NO. EE92202 CASE# ' 24-6650 DATE AND TIME 06/23/24 17:45 OF COLLISION ............�� 1 it 4 0 c. d�q t 1 lies �rSsw� PAGE 3 OF 3