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HomeMy WebLinkAbout24-10103 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-10103 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 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 09 - 1-- 2024 2223 17 ❑.❑ S 8 W e IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 203 S 2ND STREET BLOCK ST e✓ MILEPOST 200 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:6613768169 0 11 30 6� LAST NAME HOPPER FIRSTNAME JENNIFER MIDDLE C 1 1 2 31 INITIAL STREET ❑, 165 E PARKER HEIGHTS RD CITY WAPATO ST I WA 2jp, 98051 z NEW ADDRESS 7❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10� P1 aT�S� CLA6018 sTATI WAvIN# JTEHD20V750041212 TRAILER STATE TRAILER STATE 11 1 5 PLATE# PLATE# FR.. ro TRLR. TRLR 3 5 33 12 1 5 VIN#j VIN#I FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34 13 1 2005 TOYT RAV4 UT DAMAGE YES NO YES❑ No✓ REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO COUNTRY FINANCIAL P46A4209737 3 4 IN EFFECT &POLICY# 9TOP VE—LE CHARGE 5 36 LEGALLY res❑NO❑ CITATION# BOTTOM 15❑ STANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064461535 16 2 LAST NAME GITAU FIRST NAME PETER MIDDLE M INITIAL 17 STREET❑ NEW ADDREss❑' 1218 133RD ST S CITY' TACOMA ST WA ZIP 98444 4❑ 37 18❑ CDL ., IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVER'S STATE WA SEX M D.O.B. 03 _ 02 _ 1958 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑ILICENSE 21❑ PLATE# 98410C TATE 41 WA vIN1 1VHHH3V2866707620 1 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2010 MAKE DR/ MODEL MUL STYLE B(/ VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 L4❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO KING COUNTY DOT TRANSIT 5004TH AVE#653 SEATTLE WA 98014 D:2064461535 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU&PORGY#E CO KING COUNTY SELF INSURANCE N/A 1GQ IN EFFECT —ILLE ❑ ,J� CITATION# CHARGE 25 LEGALLY YES N`L J s � a 7MICAELA NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 CASTAIN 7 12573 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF18781 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10103 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' Unit 1: Toyota Rav4 (WA/CLA6018) ; Jennifer Hopper (DOB 02/17/1966) Unit 2: Orion Bus (WA/98410C) ; Peter Gitau (DOB 03/02/1958) On 09/26/2024 at approximately 2226 hours I was dispatched to an Accident with Injuries that occurred at 203 S 2nd Street, in the City of Renton, King County, WA. Upon arrival, I contacted both parties. Both parties declined medical aid. Unit 1 was traveling westbound in lane 3 around the 200 block of S 2nd Street. Unit 2 was traveling westbound in lane 1 around the 200 block of S 2nd Street. Unit 1 turned left attempting to turn into a driveway of the Safeway parking lot. Unit 1 collided into Unit 2 while attempting to turn left, Unit 1 spun around several times, before continuing to travel on the sidewalk and into the parking lot of Safeway. A witness, Nam Lai (DOB 05/01/1978), agreed on how the collision occurred. There is damage to the driver side front tire, driver side rear door panel, and driver side rear bumper panel of Unit 1. Unit 1 was unable to drive away under its own power. There is damage to the front passenger side front bumper of Unit 2. Unit 2 was able to drive away under its own power. Pictures are attached into Axon. Based on the statements made by all parties, there is proximate cause for Unit 1 in the collision. 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 M. Castain #12573 9/27/2024 Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAELA CASTAIN 09-27-24 12:41 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 9/27/2024 1:51:42 AM BADGE OR ID# 12573 ORI# WA0171300 TIME POLICE DISPATCHED; 10:26 PM TIME POLICE ARRIVED 10:28 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. EF18781 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-10103 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT'# 2 USDOT ICC# ' VEHICLE TYPE 1 CARGO 6ODY 1 ;TYPE 2 ❑ 1 28 CARRIER KING COUNTY DOT TRANSIT NAME 3 CARRIER L ADDRESS 500 4TH AVE #653 CITY SEATTLE ST WA ZIP'', 98104 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 1 AXLES O6 GI2000 + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnnRFrtP. CITY ST ZIP 6 � CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES❑N0� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREET"[—] ❑ 16 NFln+AnnRFs.� CITY'. ST 21P CDL IGNITION REDUIREE7 IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAELA CASTAIN 09-27-24 12:41 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26F7 OI BADGE 12573 O#I',WA0171300 APPROVE 9%2E7/2024 PAGE OF F 3000-345-013(R 11118) REPORT NO.! EF18781 CASE# 24-10103 DATE AND TIME 09/26/24 22:23 OF COLLISION PAGE 4 OF 4