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HomeMy WebLinkAbout24-9103 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF10396 170 27 COLLISION REP FIT 1591971 ❑ ❑ FIRE ❑ CASE$# 24-9103 2 6 0 INTERSTATE CITY STREET 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 2 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION 08 - 1-- 2024 0922 17 ❑. S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RENTON AVE S BLOCK NO. e✓ 100 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e HARDIEAVESW/TAYLOR 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES �/No D:0777543725 0 11 30 6❑ LAST NAME SHILTON FIRSTNAME STEPHEN MIDDLE M 1 1 2 31 INITIAL STREET ❑ 65 COVENTRY RD,BULKINGTON ENGLAND CITY SEATTLE ST 2jp, 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE CD SEX'M MM D Y' 03 1— 11 — 1967 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES 2❑ 3 10 1❑ PI ATES KBT6789 sTATe OH vN# 2C4RC1GG1PR593875 F_ 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 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 34 13 A 2023 CHRY VAN 4C DAMAGE YES NO MEYER YES[:] NO✓ 7 3 REGISTEREDOWNERINFO .-M03150S160THST#509 SEATACWA98188 D:8333298466 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 A LIABILITY INSURANCE INSURANCE CO 4 14 ❑ BANK OF SCOTLAND 1362889680tLI EFFECT &POLICY# TOPVEHICL CHARGE36 LECALLv Yes❑NO CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM NO OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2062909506 16 a LAST NAME DAVIDSON FIRST NAME NANCYLEE MIDDLE INITIAL 17❑ STREET ❑', 11411 CRESTWOOD DR S CITY''' SEATTLE ST' WA ZIP 98178 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCKYEs❑ND� INTERLOCK ves No� YEs NOF 19 LDIRIVERIS CENS # STATE I WA SEX F M DDY D.C.B. 10 _ 11 1946 39 20 ON DUTY STATUS AIRBAG,2 RESTR 3 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES 40 USE CLASS NECK 21❑ LICENSE I BIH8103 TATE WA VIN# 3GNCA53V49S515742 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. Gov HI VEH YEAR 2009 MAKE CHEV MODEL yp/R STYLE P4 —FEHICLE TOWED NOO✓ BLIN TOWED BY 44 fj YES NO 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGED AREA 3 4 LIABILITY INSURANCE INSU&POLICY#E CO GE/CO 0245576806IN 9TOP 5 VEHICLE YES[:] NC[:]I CITATION# CHARGE io BOTTOM LEGALLY 25 N.HVCe OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 SULIASI TAMAIVENA 12788 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF10396 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9103 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) SHILTON LYNN (/AST FIRST, ADDRESS&PHONE# ENGLAND ENGLAND 9999999999 SEXi F MMDovyvv 12 - 04 - 1969 PASSENGER Z WITNESS❑ UNIT# 1 SEAT SOS. 3 AIRBAG 2 RESTR. 9 EJECT ? 1 HELMET INJURY NATURE OF INJURIES USE CLASS '1 NAME (LAST,FIRST,MIDDLE INITIAL) PHILLIPS PETER T ADDRESS&PHONE# D O B ENGLAND 9999999999 SEX' U MMnovvvv 05 _ 28 _ 1943 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 1 POS 4 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 NAME (LAST FIRST,MIDDLE INITIAL) PHILLIPS ROSEMARYA AooREss&PHONE# ENGLAND 9999999999 U M O6 30 _ 1949 SEX. D.O.B. _ MDDYYYY PASSENGER WITNESS UNIT# ! 1 SEAT 6 AIRBAG 2 RESTR. 9 EJECT 1 HELMET NJURY 1 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. SULIASI TAMA/VENA 08-30-24 01:27 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 1 8/31/2024 11:47:35 AM BADGE OR ID# 1Y788 OR]# j WA0171300 TIME POLICE DISPATCHED 9:24 AM TIME POLICE ARRIVED',9:36 AM PART I PAGE IT]OF STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF10396 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9103 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) SHILTON STEPHANIE R (/AST FIRST, ADDRESS&PHONE# ENGLAND 9999999999 SEX i U MMDOYyry 05 - 07 - 1996 -------------------------- PASSENGER Z WITNESS UNIT# 1 SEA y AIRBAG 2 RESTR. 9 EJECT ? 1 HELMET INJURY NATURE OF INJURIES POS. USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB 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' 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. SULIASI TAMA/VENA 08-30-24 01:27 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 1 8/31/2024 11:47:35 AM BADGE OR ID# 1Y788 OR]# j WA0171300 TIME POLICE DISPATCHED 9:24 AM TIME POLICE ARRIVED',9:36 AM PART I PAGE IT]OF REPORT NO. EF10396 CASE# 24-9103 OF COLLISION 08/30/24 09:22 OF CbLLI510N NARRATIVE On 08/30/2024, at approximately hours, I was dispatched to a blocking accident at Renton Ave S and Hardie Ave SW/Taylor Ave SW in the City of Renton, County of King, Washington. Unit#1 advised that he was on Renton Ave S, facing westbound, in the left turn lane #4 (#4 being near the divider). This turn leads to Hardie Ave SW. He stated that while making the turn, the road was clear, and Unit#2 was speeding down Renton Ave S, which he could not avoid, causing them to collide. He claims no injuries, and all passengers in Unit#1 vehicles claimed no injuries. Also, none of the passengers gave any statements about the accident. I observed heavy damage to the front of the vehicle, and the front passenger tire was bent. Due to this, Gene Meyers towed the van as it was not drivable and partially blocked the roadway. Unit#1's van is registered to Alamo (car rental). The driver and passengers are all from England. Unit#2 advised she was traveling eastbound on Renton Ave S, attempting to pass Hardie Ave SW/Taylor Ave SW. In doing so, as she was crossing the intersection (also green light), Unit#1's vehicle made a left turn in front of her, causing her to collide with his van. She claimed her neck was in pain but refused medical assistance. I observed her vehicle with front bumper damage, and she said that her car was smoking and that she did not want to attempt to turn the vehicle on. Her car was safely off the roadway, and her brother will be towing her car. Photos were taken and uploaded to evidence. An information exchange was completed. They both received my business card with a case number. This concludes my report. Electronically signed by S. Tamaivena #12788 on 08/30/2024 @1120 hours in Renton, WA. PAGE 4 OF 5 REPORT NO.! EF10396 CASE# ' 24-9103 DATE AND TIME 08/30/24 09:22 OF COLLISION r i a.. PAGE 5 OF 5