Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout24-8077 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-8077 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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: OS — 1—— 2024 1740 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
OAKSDALE AVE SW BLOCK NO. e✓ 4100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e SW41ST ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:2063307750 0 11
30
6❑ LAST NAME NEJASH FIRSTNAME ARAARSO MIDDLE A 1 1 2 31
INITIAL
STREET ✓ 3021 NE 72ND DRIVE CITY VANCOUVER ST WA 2jp, 98661 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 01 1— 01 — 1984 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE CMC0849 sTArr WAVIN#' 5YFEPMAE5MP253099
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 3 5 33
12 0 0 VIN#' VIN#
>;. FROM TO
VEH.YEAR 2021 TOYT COROL MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES No YES[:] No
✓
REGISTERED OWNER INFO ARAARSO NEJASH 10224 RENTON AVE S SEATTLE WA 98178 D:2063307750 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GIECO 4221781307 3 4
IN EFFECT &POLICY# STOP
VEHIc� CHARGE 1 5 36
LFGALLv YES No CITATION# 4AO424885 FAIL YIELD LEFT TURN MOTOR o Borrom
15❑ STANDING 6
�UNIT MOTOR PEDAL-: ❑ PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLD MET PHONE
02 VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME COLLER FIRST NAME RYAN MIDDLE 10
INITIAL
17 STREET❑ NEW ADOREss❑' 13504 107TH AVENUE CT E CITY' PUYALLUP ST WA ZIP 983743892 4❑ 37
18❑ CDL ., IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NOR INTERLOCK YEs❑NOF YEs❑NOF
19[ DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ 41
21❑ PLATE# AVC5014 TArE WA vIN# 1GKEK63U94J185381 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2004 MAKE GMC MODEL YUKON STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO RYAN COLLIER 13504107THAVENUE CTE PUYALLUP WA 98374 D:2532548067 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# IGQI
VEHICLE Yes Nc❑ CITATION# 4AO424886 CHARGE OP MOT VEH W/OUT INSURANCE
cn r
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEITH PETTY 12809 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF02469
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8077
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 was traveling west bound on SW 41st ST. Unit 1 stopped at the intersection of SW 41st St and
Oakesdale Ave SW. Unit 1 intended to turn to the left onto Oakesdale Ave SW and failed to yield the
right of way to unit 2 traveling northbound on Oakesdale Ave SW.
Unit 1 front driver side struck the front passenger side of unit 2 causing over $1000 of damage. Unit 2
had to be towed.
Upon request Ryan O Coller driving Unit 2 was unable to provide proof of insurance.
Unit 1 was issued a citation under RCW 46.61.185 vehicles turning left.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
"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: K. Petty, Date: 08/01/24t 1843 hours, Place: Renton, King County, WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEITH PETTY 08-01-24 07:17 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 81512024 2:21:58 PM
BADGE OR ID# ! 12809 OR]# WA0171300 TIME POLICE DISPATCHED! 5:43 PM TIME POLICE ARRIVED;5:51 PM
PART I PAGE IT]OF 3�
REPORT NO. EF02469 CASE# ' 24-8077 DATE AND TIME 08/01/24 17:40
OF COLLISION
t
„towl's .,
fit..
---------------------------------------
t ,s
a
v
�t
PAGE 3 OF 3