HomeMy WebLinkAbout24-8264 ITFF' "POLCERA II I !�� I III I III I ]III III II I . 0 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 24-s2sa 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 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'. 08 - 1-- 2024 1650 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
EASTVALLEYRD ST e✓
MILEPOST Y233
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:2532946657 0 11
30
6� LAST NAME HOLLE FIRSTNAME MIKAYLA MIDDLE W 1 1 2 31
INITIAL
STREET ❑, 13732 12TH AVE SW,APT 64 CITY BURIEN ST WA Zjp, 98166 z
NEW ADDRESS
7❑ CDL 1/ I IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 . EJECT 1 HELMETU E 2 CLASS 7 [NATURE OF INJURIES
MINOR BLEEDING ON CHEST z❑
3
10 9❑ PI ATE 14 D17469E STATE WA VIN#' 1FTPF17L1YKA92061
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM ro
TRLR. TRLR 5 7 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 1 5 34
13 4 2000 FORD F150 PK DAMAGE YES NOBS YYES[:] No✓
REGISTERED OWNER INFO ALLY WASTE SERVICE 100 N HOWARD ST SPOKANE WA 99201 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO ACORD HLM51CL07134271 3 4
IN EFFECT &POLICY# 9TOP
LVEHIa.E 5
LEGALLY YES�No D CITATION# 4A0531409 CHARGE 36 FAIL YIELD LEFT TURN MOTOR )o eorrom
15❑ NDING 8 6
MOTOR PEDAL- :PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065578863
16 a
LAST NAME EDLEMAN FIRST NAME MIA MIDDLE A
INITIAL
17❑ STREET NEW ADOREs7 14435 28TH LN S CITY' SEATAC ST WA ZIP 98168 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NoF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 05 _ 10 _ 2006 39
LICENSE# MMDDYY
20❑ USE CLASS MINOR ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
PAIN
❑LICENSE I 21❑ PLA E# CCW6824 TATE 41
WA VIN# 4T1BE32K62U508894 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2002 MAKE TOYT MODEL CAMRY STYLE SD I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO LAURA TROVES]1443528TH LN S SEATAC WA 98168 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &PORGY#E CO MIDDLESEX INS CO 11407965607IN 9TOP 5
VEwcLe ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N J
25 8 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# [AGENCY
26
BENJAMIN FLICK 12825 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF05647
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8264
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 FIRST 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
BENJAMIN FLICK 08-06-24 06:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/16/2024 11:36:55 AM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED 4:51 PM TIME POLICE ARRIVED',4:55 PM
PART I PAGE IT]OF 4�
REPORT NO. EF05647 CASE# 24-8264 OF COLLISION
08/06/24 16:50
OF CbLLI510N
NARRATIVE
24-8264
On 08-06-2024 at approximately 1650 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision at
2233 East Valley RD.
Upon arrival I made contact with both vehicles involved. Both involved drivers agreed upon the
circumstances that occurred.
Both parties stated they had very minor injuries and they were evaluated by Renton Fire on scene.
Unit 02 was driving southbound on East Valley RD.
Unit 01 was in the turn lane facing northbound on East Valley RD. Unit 01 driver tried to shoot
through a gap in the traffic, turning into the address 2233 East Valley RD, but failed to yield right of
way to unit 02.
Unit's 01 and 02 then collided in the southbound lane of East Valley RD.
I provided both parties with an exchange of information and a business card which contained the
case number.
I observed that the damage to the vehicles was consistent with what the parties had told me.
At the conclusion of my investigation, I believed that the proximate cause of the collision was that the
driver of unit 01 had not yielded right of way to the driver of unit 02. 1 confirmed with the driver of unit
01 that her DOL address was current. I informed her that he would be receiving a citation for failure to
yield right of way via mail.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 08-06-2024 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EF05647 CASE# ' 24-8264 DATE AND TIME 08/06/24 16:50
OF COLLISION
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PAGE 4 OF 4
