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HomeMy WebLinkAbout24-7705 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-7705 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION' 07 - 1-- 2024 0702 17 ❑.❑ S 8 W e IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ KIRKLAND AVE NE BLOCK NO. e✓ 1500 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ e S ❑❑ FEET VV e NE 15TH ST 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2563073617 0 11 30 6� LAST NAME CAMPBELL FIRSTNAME ERBAL MIDDLE C 1 2 31 INITIAL STREET ❑ 1506 KIRKLAND AVE NE CITY RENTON ST WA ZIP 98056 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/ ❑ DRIVER'S' STATE AL SEX'F M".O B 08 1- 21 - 2003 1 2 32 8 LICENSE# 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H USEELMET 2 CLASS 7 INJURY [NATURE OF SORE LEFT LEGS 2❑ 3 10 9❑ P1 ATNES# CMC3354 sTAT WAu N# 3VWVA7AT5CM628574 5 ----� TRAILER STATE PLAT Eft STATE 11 2 PLATE# PLATE# FROM TO TRLR. YRLR. 3 5 33 12 2 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34 13 2012 YOLK BEETLE 2D DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO CAL.POWELL 1506 KIRKLAND AVE NE RENTON WA 98056 D:6783711465 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO INTEGON NATIONAL INS 2022595599 3 4 IN EFFECT &POLICY# 9TOP vErIICE CHARGE 5 36 LECALLv YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254433047 16 a LAST NAME MOGOLLAN GARCIA FIRST NAME ROBERTO MIDDLE N INITIAL 17❑ STREET ❑', 1318 KIRKLAND AVE NE CITY' RENTON ST WA ZIP 980563217 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 DRIVER'S STATE WA SEX M D.C.B. 04 15 _ 1979 39 LICENSE# MMDDYY HELMET {NJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑ 21❑ LICENSE BRJ4579 TATe WA vIN# JHLRD78926C058922 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. I VEH YEAR 2006 MAKE yOND MODEL CR_V STYLE 5D jVEHl DAMAGE TO WED NOO✓ BLIN TOWED BY Gov 44 Yr H YES NO 1/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE &POLICY#E CO PEMCO CA 1772974IN 9TOP 5 'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM LEGALLY YES N`L J 25 ' e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 C.STEED 8770 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE98100 COLLISION REPORT III III III III III 111 1591972 CASE# 24-7705 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' On 07/22/24 at about 0718 hrs I arrived at Kirkland Ave NE and NE 15th St for an injury collision, in the City of Renton, County of King, and State of Washington. Unit#1 was identified by her Alabama Driver's License and Unit#2 was identified by his WADL. Unit#2 was NB on Kirkland Ave NE approaching NE 15th St and had the right of way. Unit#1 was WB on NE 15th St and turning SB on Kirkland Ave NE. Unit#1 had a stop sign. Unit#1 pulled in front of Unit#2. Unit#1 was struck on the front driver's side with the front end of Unit#2. The driver of Unit#1 complained of pain on her left leg from the collision. She also advised Unit#2 was speeding. The driver of Unit#2 said he was traveling at around 27 mph and he did not think the driver of Unit#1 even saw him. This incident was captured on my body worn video camera. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. The video was uploaded to evidence.com. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically Signed by Officer Steed on 07/22/24 0825 hrs, Renton Washington Cassidy Steed/8770 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.STEED 07-22-24 08:45 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 7/22/2024 11:28:27 AM BADGE OR ID# 8770 OR]# WA0171300 TIME POLICE DISPATCHED 7:03 AM TIME POLICE ARRIVED',7:18 AM FART I PAGE IT]OF 3� REPORT NO.! EE98100 CASE# 24-7705 DATE AND TIME 07/22/24 07:02 OF COLLISION ¢, 1 h PAGE 3 OF 3