Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout24-6851 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-6851 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4150 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 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#
COLLISION.. 06 - 1-- 2024 2330 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE CARR RD BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 106TH PL SE
0 1 29
UNIT 01 MOTOR CYCLE
❑ YES ]NO
MET PHONE 0 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES No YES No
8❑ LIRCIENSRE#
STA fE I
SEX u MMDOBYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE srATI urN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR m 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R T 34
13❑ DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEF" 5 36
LECALLv YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4256529549
16 a
LAST NAME UNDERWOOD FIRST NAME AZZIEM MIDDLE H
INITIAL
17 NEW STREETR 7' 14600 SE 176TH ST UNIT P1 CITY RENTON ST WA ZIP 98058 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t-T�RANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YES It1 I NoF t l YES NO
19 DRIVER'S STATE WA SEX U I D.C.B. O6 _ 24 1960 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS LEFT HAND PAIN
LICENSE I ❑21❑ PLATE# MEIZZA TATE 41
WA VIN# 1YVHZ8DH005M38137 `1
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
TOWED eY Gov HI 44
VEH YEAR 2012 MAKE MAZp MODEL MZ5 STYLE SD DAMAGE TOWED✓ NOO BLIN BANKERS YES No
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSURANCE
#E CO PEMCO CA0825257IN STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N
e
7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# [AGENCY
26
MIN FLICK 12825 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE92589
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6851
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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
BENJAMIN FLICK 06-30-24 12:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 7/3/2024 11:45:17 PM
BADGE OR ID# 12825 OR]# WA0171300 TIME POLICE DISPATCHED! 11:36 PM TIME POLICE ARRIVED',11:38 PM
PART I PAGE IT]OF 4�
REPORT NO. EE92589 CASE# 24-6851 OF COLLISION
06/29/24 23:30
OF CbLLI510N
NARRATIVE
24-6851
On 06-29-2024 at approximately 2336 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision at the
intersection of 106th PL SE and SE Carr Rd. Prior to my arrival, the suspect vehicle driver failed to
provide any information and then drove away from the scene. The victim/reporting party met me in
the parking lot of the US Bank at 108th AVE SE and SE Petrovitsky RD.
The victim/reporting party of unit 02 was as follows:
Unit 2: (WA/MEIZZA) driver Azziem H. Underwood (DOB: 06-24-1960 via WADL)
The suspect vehicle was as follows:
A grey sedan. Unknown further.
Driver Underwood was driving eastbound on SE Carr RD and was proceeding through a green light
on 106th PL SE when the suspect vehicle proceeded north through a red light from the Fred Meyer
Parking lot. The suspect vehicle collided with the victim vehicle and then fled the scene immediately,
driving westbound in the eastbound lanes of SE Carr RD. Victim Underwood was able to limp his
vehicle to the nearby parking lot, but the airbag had deployed and there was significant front end
damage. Victim Underwood's glasses were broken/bent from the airbag.
I provided Underwood with a business card which contained the case number.
An area check for the suspect vehicle had negative results.
Underwood told me that his left hand hurt as a result of the collision. I asked him if he wanted medical
attention, he told me he did not.
I believed that there was PC for felony hit and run for the unidentified driver of the suspect vehicle,
since victim Underwood complained of pain in his hand. At the time this report was written, the
suspect and suspect vehicle had not been located, nor identified.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 06-30-2024 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE92589 CASE# 24-6851 DATE AND TIME 06/29/24 23:30
OF COLLISION
ANSE Carr, not to scale
� 1
e
1
I i
PAGE 4 OF 4