HomeMy WebLinkAbout24-9445 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF13090 170
27
COLLISION REP FIT 1591971
CASE 24-9445 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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 CITY#
COLLISION'. O9 - 08 - 2024 2112 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 180TH ST BLOCK NO. e --- ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e OAKSALDEAVESW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:5094402462 0 11
30
6� LAST NAME KERKOW FIRSTNAME RICHARD MIDDLE B 1 1 2 31
INITIAL
STREET ❑ 51O S GEORGIA ST CITY KENNEWICK ST WA Zjp, 99336 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE AML2920 sTArI WAurN# 3C4NJDC67KT753411
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR 2019 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 JEEP COMPA UT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO RICHARD KERKOW 5f0 S GEORGIA ST KENNEWICK WA 99336 D:5094402462 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO UNITED SERVICES 000755873U 3 4
IN EFFECT &POLICY# 9TOP
ve'CLE CHARGE 5 36
LEGALLv Ye6❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069462442
16 a
LAST NAME HANS FIRST NAME HARKARAN MIDDLE IS
INITIAL
17 STREET I❑ s❑' 20014 95TH PL S CITY' KENT ST WA ZIP 98031 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE I WA SEX M D.C.B. 10 _ 25 _ 1994 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CKX8637 TArE 41
WA VIN 1 WDD7X8KBOKA005936 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE MERZ MODEL AMG GT STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HARKARAN HANS 2001495THPL S KENT WA 98031 D:2069462442 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO FARMERS 7611407190IN STOP 5
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' a
7TRADER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 4553 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF13090
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9445
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) KERKOW CAROL E
(LAST FIRST,
ADDRESS&PHONE#
510 S GEORGIA ST KENNEWICK WA 99336 5093086699 SEX i U MMDDYyry 12 - 15 - 1941
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ �+ 1 POS. 3 6 4 1 USE 1 2 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'
On 09/08/2024 at approximately 2128 hours, I was dispatched to a two vehicle non injury collision
that occurred at S 180 th ST and Oaksdale AVE SW, in the City of Renton, County of King.
I arrived and spoke with both drivers and they conveyed the following. The driver of Unit 2 Hans was
in the number two lane going straight ahead. The driver of Unit 1 was in the number 1 lane traveling
EB and made an unsafe left turn colliding with Unit 2.
The proximate cause of the collision was the unsafe left lane change made by Unit 1. There were no
injuries and Unit 1 acknowledged making the unsafe turn.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.TRADER 09-08-24 11:22 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 9/8/2024 11:23:29 PM
BADGE OR ID# 4553 OR]#' > WA0171300 TIME POLICE DISPATCHED 9:Y9 Pry] TIME POLICE ARRIVED 9:31 PM
PART I PAGE IT]OF 3�
REPORT NO.! EF13090 CASE# 24-9445 DATE AND TIME 09/08/24 21:12
OF COLLISION
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