HomeMy WebLinkAbout24-6914 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-6914 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4'/00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 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# ❑
CtLLISION' 07 - 01 - 2024 2207 17 ❑-❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 4 29
MOTU '�01 VEHIOR Z CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ ODL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYES No✓ INTERLOCKYEs NO✓ vES No✓
8 DRIVERS STATE SEX U D.QB 32
❑ :LICENSE# MMDDYY —=
9❑ ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 9❑ P1 AT 14 BfF8215 STATE WA VIN# 1J4FT58S9Ml510284
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. TRLR m 33
12❑ VIN#' UIN#'
FROM TO
VEH.YEAR 1991 MAKE JEEP MODEL CHERO STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
DAMAGE YES NO ✓ YES❑ NO✓
13❑ REGISTERED OWNER INFO ANTHONYADAMS48811284THAVESEENUMCLAWWA98022 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY#VEHICLE CHARGE 36
LEGALLv YES NO CITATION# CQ
15❑ STAIN,DIING 8 7 6
UNIT 02 vEHIMOTOCLE ❑ CYCLE ❑ PEDESTRIAN ❑✓ PROPERTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME HANSON FIRST NAME JAMES MIDDLE D
INITIAL
17 STREET I❑ 9001 9TH AVE E CITY TACOMA ST WA ZIP 98445 37
NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICALt—T�RANSPORTED 38
INTERLOCK YES�NOR INTERLOCK YEs It I No� YES t l NO❑
19 LICENSE#DRIVER'S STATE WA SEX MMDC7YY
M D.O.B. 09 _ 17 1974 39
IES
20 ON DUTY STATUS 0 AIRBAG RESTR EJECT I H U SE
2 LASSY 6 VEHICLE RANROVER TORSO ❑ 40
❑21❑ LICENSE TATE 41
VIN# `1
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE pLATE#ILER STATE
23❑ 43
TRLR RLR
UIN It 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 1 ] DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGQ
VEHICLE ❑ C[:] CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
O
F
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
EDIGER 12807 WA0171300
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE93027
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6914
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.
TYLER EDIGER 07-02-24 12:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
GREGORYBILLS 12495 71512024 10:32:36 PM
BADGE OR ID# 12807 ORI# WA0171300 TIME POLICE DISPATCHED; 10:07 PM TIME POLICE ARRIVED 10:09 PM
PART I PAGE IT]OF 4�
DATE AND
REPORT NO. EE93027 CASE# 24-6914 OFCOLISION 07/01/2422:07
OF COLLISION
NARRATIVE
24-6914
On 07/01/2024 at approximately 2208 hours I was dispatched to an unknown injury accident at
Speedway Gas Station, 765 Rainier Ave S, in the City of Renton, King County, WA.
The reporting party advised dispatch that there was a single vehicle into a tree in the parking lot of the
aforementioned location.
I arrived on scene and contacted a male who appeared to be in pain, leaning up against a vehicle. I
later identified the male as James D Hanson (DOB 09/17/1974) by his WADOL photo. Other officers
identified the vehicle as a 1991 Jeep Cherokee (WA/Lic: BIF8215 VIN# 1J41FT58S91VIL510284).
James was having difficulty talking but I was able to gather that he was working on the vehicle, and
that he had been run over by it. James stated at one point that he was working on the solenoid and
did not know the vehicle was in gear.
James was unable to tell me where he was hurting but he had some minor scrapes on his arms and
bruising on his midsection.
An unidentified witness advised Officer Castain that James was standing in front of the vehicle
working on it when the vehicle began rolling forward. This caused James to lose his balance, falling
to the ground where he was run over by the tires on the vehicle.
James was transported by medics to Harborview Medical center with possible internal injuries.
Based on where the vehicle was, I am led to believe that it was at one of the gas pumps facing west,
and rolled westbound from that gas pump coming to a stop once the two front tires went up on the
curb and the front bumper hit a small tree.
I took pictures of the vehicle, and those images were uploaded through Axon. The employee at
Speedway was unable to review video footage but I provided her with the case and my email address
to send the video at a later time.
Nobody was operating the vehicle at the time of the collision and it appears the collision was caused
by James failing to put the vehicle in park.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer T. Ediger#12807 07/01/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EE93027 CASE# 24-6914 DATE AND TIME 07/01/24 22:07
OF COLLISION
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