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HomeMy WebLinkAbout24-8789 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 SASE 24-8789 2 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 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 1916 17 =-= S 8 IN e 1070 3 4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RAINIER AVE S BLOCK NO. e ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 1.❑ FEET e S ❑ W HF j GgApyWAy 0 3 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El No ,/ I D:4255301057 0 11 30 6❑ LAST NAME GREEN FIRSTNAME JEFFREY MIDDLE J 1 1 2 31 INITIAL STREET ❑ 7207 114TH AVE NE CITY LAKE STEVENS ST WA 21p 98258 z 'NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO 8❑ LDRIVER # STATE WA SEX'M MID -O B 08 1— 09 — 1962 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� C16470Y sTArI WAurN# 1N6ADOEVOEN750678 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 7 5 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR ZO14 MAKE NISS MODEL FRONTI STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 13❑ DAMAGE YES NO YES[:] NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 2 3 4 14 LIABILI INSURANCE INSURANCECO HARTFORD ACCIDENT AND INDEMNITY 52 PH 431817-810272 IN EFFECT &POLICY# VEHICLE CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ cvcLE ❑ ❑ OWNER ❑ YEs No ,/ D:2538838627 16 a LAST NAME VAN SCYOC FIRST NAME MARTIN MIDDLE C INITIAL 17❑ STREET ❑' 6649E TONIA ST CITY TACOMA ST' WA ZIP 98404 37 NEW ADDRESS ❑ 18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19[ DRIVER'S STATE WA SEX M D.C.B. 01 28 _ 1967 El 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑ 21❑ LICENSE D7557C TAre WA VIN1 15GGD301XC1180592 ❑ 41 PLATE# 42 22❑ PLATE# STATE pLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2012 MAKE GILL MODEL G30D STYLE B(I VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO,� YES NO REGISTERED OWNER INFO MARTIN VAN SCYOC 6649 E TONIA ST TACOMA WA 98404 D:2538838627 VEHICLE NO.2 SHADEDAMAGED AREA 3 4 INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5 VE"LE ❑ ,J� CITATION# CHARGE io BOTTOM LEGALLY YES N J 25 s a =TAMAIVENA AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12812 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF07884 COLLISION REPORT III III III III III 111 1591972 CASE# 24-8789 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 08-20-2024, at approximately 1916 hours, while employed as a uniformed Patrol Officer for the City of Renton, I was dispatched to a blocking accident located at Rainier Ave S and S Grady Way, within the City of Renton, County of King, State of Washington. The Driver of Unit 2 is Van Scyoc, Martin C (DOB 01-28-1967). Martin is the Puget Sound Bus driver of a 2012 Gillig G30D with license plate WA/D7557C. The Driver of Unit 1 is Green, Jeffrey J (DOB 08-09-1962). Green is the registered owner of a 2014 Nissan Frontier with license plate WA/C16470Y. Unit 2 stated that he was traveling southbound on Rainier Ave S in lane 2, crossing S Grady Way, when Unit 1 tuned into his lane, causing Unit 1's vehicle to hit Unit 2's. Unit 1 stated that he was traveling eastbound on lane 1, approaching Rainier Ave S. Unit 1 was turning right to enter Highway 167, going southbound. He said he did not know he was going into the same lane as Unit 2, which caused Unit 1 to collide with Unit 2. There was minor damage to both vehicles. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. This report was electronically signed by Officer Si. Tamaivena #12812, August 21, 2024, at 0108 hours, Renton, WA. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. SITIVENI TAMAIVENA 08-21-24 01:09 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT P.SUMMERS 8887 8/23/2024 7:30:47 PM BADGE OR ID# ! 12812 ORI# WA0171300 TIME POLICE DISPATCHED 7:25 PN1 TIME POLICE ARRIVED]7:29 PN1 PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. EF07884 r` POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-8789 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT'# 2 USDOr ICC# ' VEHICLE TYPE 1 CARGO BODY 1 TYPE 2 ❑ 1 28 CARRIER NAME. WASHINGTON STATE TRANSIT ..... 3 CARRIER ADDRESS 3701 96TH ST SW. CITY LAKEWOOD ST WA ZIP'', 98499 4 ❑ NAME # PLACARD: :❑ SOURCE 3 AXLES 03 GwvR 1 10000 + NAME IF NO NUMBER 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 INTERLOCK 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 STREETIAL ❑ 16 NFln+AnnRFs.� CITY'. ST 21P CDL IGNITION REDUIRED 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. SITIVENI TAMAIVENA 08-21-24 01:09 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12812 O#I',WA0171300 SUMMERS 8/23/2024 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EF07884 CASE# ' 24-8789 DATE AND TIME 08/20/24 19:16 OF COLLISION �.r 5 \ \ e y yti a PAGE 4 OF 4