HomeMy WebLinkAbout24-8670 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF06203oc� RA
COLLISION REPORT 1591971
CASE# 24-8670 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOt'ALNENO'Y. 4200 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ TRIBAL TOTAL UN TS#OF 02 SOTRUCK 2 4 28
RESERVATION I 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 08 - 17 - 2024 1655 17 =.�� S W e IN
OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE SUNSET BLVD BLOCK ST e
4a MILE POST 4000 .�
❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5 1❑ 25 00 FEET e✓ S 8✓ W e UNION AV NE
1 3 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE ❑ CYCLE ❑ YES No �/ D:4253016047 1 5 30
5❑ LAST NAME FRANDSEN FIRST NAME KAYLEE MIDDLE E 31
INITIAL
STREET ❑ 14815 SE 116TH ST CITY RENTON ST I WA ZIP 980596027 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO�/ INTERLOCKYEs NO�/ YES No�/
8 DRIVECEN STATE WA SEX F MMor YY' 09 — 04 — 2003 1 2 32
9� ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 9 CLASS 1 NAruRE of INJURIES 2
LICENSE, CKF6096 STATE WA VN# 5NIANONW6BC514077 3
10[9� PI ATP rt
11[-j— TRAILER STATE TRAILER ,STATE
11 O 0 PLATE# PLATE# FROM TO
TRLR TRLR m 33
12 0 Q VIN# VIN
FROM TO
VEH.YEAR ZOII MAKE NISS MODEL XTERRA STYLE SV VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE Q Q 34
DAMAGE YES DNO YES NO
13� REGISTERED OWNER INFO KAYLEEFRANDSEN 14815 SE 116TH ST RENTON INA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
A LIABILITY INSURANCE NSURANCE CO 3 4
14 ALL STATE 987023235
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t 5 36
Lemur YES❑NO❑ CITATION# 7 o BOTTOM
15❑ ANowG e
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
VEHICLE
UNIT 02 CYCLE OWNER Q ❑ PEDESTRIAN ❑ D:2065917311
YES NO
16�
LAST NAME WINTERS FIRST NAME JUSTIN MIDDLE I R
INITIAL
STREET ❑
17� '❑ 500 MONROE AV NE H4 CITY I RENTON ST, Wq ZIP 98056 37
NEW ADDRESS
1g❑ CDL IGNITION REQUIRED (GNTION PRESENT MEDIGALTRANSPORTED' 38
INTERLOCKYEs No INTERLOCK YES No rEs NO
19 F] DRIVER' # STATE SEX U MMDOYY 12 31 1989 ❑ 39
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E CLY7795 TATE WA VIN# JNRDR09Y63W304631 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2003 MAKE /p/F/ MODEL (,�X4 STYLE GA VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO RAVEN WtNTERS 500 MONROEAVNEH4 RENTON WA 98056 VEHICLE NO,2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
vewae ❑ ,.I—I CITATION
CHARGE tO BOTTOM
LEGA��Y YES N`LJ
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HANSEN HSU 12651 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF06203
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8670
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} FRANDSEN CORRINEE
(LAST,FIRST
ADDRESS&PHONE# DOB
14815 SE 116TH ST RENTON WA 980596027 4253016047 SEX' F MMDDYYYY 09 - 11 - 1976
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
�', 1 POS. 3 2 4 1 USE CLASS 11
'NAME
LAsr F RST,MIDDLE INITIAL) HUBSCHMITT KARA J
ADDRESS&PHONE# D C,B
10512 126TH AV SE RENTON WA 98056 4259705400 SEX' F MMDDVVYv 10 _ 01 _ 1998
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ �✓ POS. USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M _T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. CLASS r— ----j
NARRATIVE
Unit 1 parked in parking lot of storefront at 4033 NE Sunset Blvd, at the southwest corner of Union Av
NE and NE Sunset Blvd. Unit 2 improper backing into Unit 1 which causes non reportable non
disabling dent in the front driver quarter panel of Unit 1. Unit 2 does not remain on scene and circles
around block, only to return again. Unit 2 driver then provided Unit 1 driver with the name of Jason
Robert and a phone number of 206 591-7311. Unit 1 driver, passenger, and witness for Unit 1 all
describe Unit 2 driver as a white taller male, slender build. Based on the license plate of Unit 2 at
scene, the phone number provided, and past police contact history with said Unit 2, Unit 2 driver was
believed to be Justin Winters. Unit 1 passenger later positively identified driver of Unit 2 as Justin
Winters via his WA DOL photo. Unit 1 driver did not wish to assist in criminal prosecution, only civil
restitutiton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 08-17-24 07:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 8/18/2024 9:53:12 PM
BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED; 5:25 PM TIME POLICE ARRIVED 5:Y7 Pry]
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EF06203 CASE# 24-8670 DATE AND TIME 08/17/24 16:55
OF COLLISION
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