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HomeMy WebLinkAbout24-10217 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF50384OLCERA COLLISION REPORT 1591971 CASE# 24-10217 2 INTERSTATE CITY STREET FIRE I RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3I M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s on' 09 - 30 - 2024 0936 17 =.= S 8 W e OF IN e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ 103RD AVE SE BLOCK NO. e 17600 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------ 1.1 FEET e S 8 W e SE CARR RD 0 3 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2532055555 0 8 30 6 LAST NAME CHOI FIRST NAME DANIEL MIDDLE J 1 1 2 31 INITIAL STREET ❑ 18320108THPL SE CITY; RENTON I ST WA ZIP; 98055 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NOR] INTERLOCKYEs Nd�/ YES ND�/ 8❑ DCIENSE# STATE WA SEXI M MMDDYY' 07 — 26 — 1987 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N U EET 2 LJAU SY 1 [NATURE of INJURIES 2 LICENSE, CGG3874 STATE WA VIN# KMHLL4AG1PU437284 3 10 F PI ATP rt TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR rRLR 1 1 7 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR ZO23 MAKE HYUN MODEL ELANTR STYLE 4D VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 9 34 13� DAMAGE YES II_II NO YESII_I) NO REGISTERED OWNER INFO T&S DENTAL GROUP 3016 BENSON RD S RENTON WA 98055 D:3609327743 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 2 LIABILITY INSURANCE INSURANCE CO 2 3 4 14 STATE FARM 559 7652 E18 47 IN EFFECT &POLICY# 4TOP CHARGE 5 36 Lemur yes❑NO❑ CITATION# 7 0 90TTOM 15❑ STM ING s 7 e MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES NO �/ D:2065326031 16F1 LAST NAME CAI FIRST NAME Q/QI MIDDLE' INITIAL ❑ 17 STREET� ❑ 3007 S PORTLAND ST CITY'.. SEATTLE ST, WA ZIP 98188 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 38 INTERLOCKYES No INTERLOCK YES NO YES No;� 19 DRIVER'S ' STATE WA SEX,F I D-O.B. 04 05 1992 � 39 LICENSE# MMDDYY HELMET INJURY: NATURE OF INJURIES 40 20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT '1 2 6 ❑ USE CLASS SORE LOWER BACK 21 LICENSE I PATE# CBL2884 rare WA vIN# 3MVDMBBL4NM402793 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 43 23 VfN RLR UIN#. 'IN# VEH.YEAR 2022 MAKE MgZp MODEL C)(_30 STYLE 4p VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO NO REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NQ.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCECO AMERICAN FAMILY 41081.53148.81 IN EFFECT &POLICY# I STOP vemae E VEHICLE YES N,.I—I CITATION# CHARGE to BOTTOM V 25 s s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 C.STEED 8770 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF50384 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10217 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE GLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE O'SS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE On 09/30/24 at about 1006 hrs I arrived at 103rd Ave SE and SE Carr Rd for an injury collision, in the City of Renton, County of King, and State of Washington. The driver of unit#2 advised she was stopped at a stop sign in the SB lane of 103rd Ave SE at S Carr Rd when she was rearended by Unit #1. 1 observed minor damage to rear of Unit#2 and the driver complained of lower back pain. Renton Fire treated the Driver of Unit#2. The driver of Unit #2 had a strong language barrier but was able to relay information with help of friends who were on scene. She said that driver of Unit#1 left a phone number and even provided photographs of the vehicles' damage before they left. I was able to contact driver#1 by telephone and he relayed that he was trying to give the driver of Unit#2 all the information but was unable due to the language barrier. The driver of Unit#1 said he was behind Unit #2 when she started to turn WB on SE Carr Rd. Driver#1 said he started to turn as well but the driver of Unit#2 stopped again partially blocking the outside WB lane of SE Carr Rd. The driver of Unit#1 said he was following too closely and rearended unit#2. 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 09/30/24 1149 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 09-30-24 11:50 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 1212712024 3:58:08 AM BADGE OR ID# ; 8770 ORI# WA0171300 TIME POLICE DISPATCHED 9:52 AM TIME POLICE ARRIVED i 10:06 AM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EF50384 CASE# 24-10217 DATE AND TIME 09/30/2409:36 OF COLLISION trY k yt t t t; t t � T t � 2 L pit v i V M � Iu w �r t t1v 1 Jay, tit a � h$�, �?�;k, ., 'u��u xwbvu���i r ""r� '•L)n�, ui ,a���u�s.r'. PAGE 3 OF 3