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HomeMy WebLinkAbout24-9478 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 INTERSTATE ❑ CITY STIR FIRE CASE EET ❑ 24-sa78 2 RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION'. O9 - O9 - 2024 1759 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ MAIN AVE S BLOCK NO. e✓ 200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 10 1. 00 FEET MILES e S B W e S SECOND ST 0 7 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:4252264652 0 7 30 5❑ LAST NAME PAVELIN FIRSTNAME DIANE MIDDLE G 1 1 2 31 INITIAL STREET ❑, 1455 S PUGET DR C102 CITY RENTON ST WA ZIP 98055 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 ,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'F MID .O B 05 1— 08 — 1959 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 ATE B4 ABV3570 JBTATIJ WAV N# 1J4EZ58S8TC102738 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# ROM ro TRLR. TRLR 1 9 33 12 0 0 VIN# VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 9 34 13 4 1996 JEEP GRAND UT DAMAGE YESNo YYES[:] NO ❑ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE INSURANCE CO STATE FARM 461 5329-F05.47 3 IN EFFECT &POLICY# 9TOP AR VEwcLE CHGE 35 LEGAL 'C YEs Z NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 7 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2063066546 16 a LAST NAME GENANEW FIRST NAME GENANEW MIDDLE B INITIAL 17 STREET NEW ADDREs7 3815 NE 4TH ST APT B36 CITY RENTON ST WA ZIP 98056 37 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCK YES❑No� INTERLOCK yEEsl I I NOF YEs t l NO� 19 D IVEW # STATE WA SEX F Mr D.C.B. 01 01 1962 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 1 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑21❑ PLATE# AEV5642 TArE 41 WA VIN# 4T1BF3EK16U130833 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GI VEH YEAR 2011 MAKE 7'Dy7- MODEL CAMRY STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO,/ 44 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE &POINSURGY#E CO GEIC04472-75-27-26IN 1 9TOP VE."LE ES N CITATION# CHARGE � i o BOTTOM LEGALLY Y 25❑ J s 7BRYAN NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26NAME 12489 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF16910 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9478 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) BUI KHO/T (LAST FIRST, ADDRESS&PHONE# D O.B. ' 2013 ABERDEEN PL SE RENTON WA 98055 7144231250 SEX M MMDDYyry 07 - 15 - 1994 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ ❑✓ POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# DOB E MMDDYYYY PASSENGER ❑WITNESS❑ UNIT# SEAT I AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit one and and two were heading south bound and stopped in traffic at the traffic light at Bronson Way South and South 2nd St when unit was struck from behind and pushed into unit two. The suspect vehicle described as a large dark colored SUV or truck fled the scene west on South 2nd St after the crash. After reviewing traffic cameras, the suspect vehicle appears to be older 90's model black colored Chevrolet Suburban with license plates. No injuries were reported and both vehicles sustained minor damge. I called the witnsess who indicated he was stopped at the traffic light heading north on Main Ave S. They witnessed the crash and got a partial plate of"B17272" for the suspect vehicle. Since the suspect vehicle was not on location and unable to locate it, I provided both drivers of unit one and two a SECTOR exchange of information. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BRYAN GROZAV 09-13-24 11:25 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 9/21/2024 5:44:40 AM BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED; 8:08 Pry] TIME POLICE ARRIVED'6:13 PM PART Ei PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EF1691 O r`) POLICE TRAFFIC 1 1 7 27 COLLISION REPORT CASE# 24-9478 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES NO 0 1 29 LAST NAME : UNKNOWN FIRST NAME , MIDDLE INITIAL STREET 30 NEW AnnRFS CITY RENTON ST ZIP 6 CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YES[:]NO zERLOCK YES❑N0� vES N DRIVER'S STATE I SEX U M��OVSYv' -� 2 LICENSE 7F-ION DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR MAKE CHEV I MODELSUBURB STYLE UT VEHICLE TOME E T SABLIN TOWED BY anvi vFH1C P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO.7NEW7 RENTON 1 5 33 12 � SHADE IN DAMAGED AREA 4 FROM TO ((ABILITY INSURANCE INSURANCE CO IN EFFECT &POLICY# R 701x VEHICLE 1l1 BorruM 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE gg�@ STANDING S} l:9 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE � OWNER YES DAMAGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME I MIDDLE 36 STREETINITIALITIAL ❑ 16 NEW AnnRFs� CITY ST ZIP CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO ❑ 17 5 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 ❑ [441 TRLR TRLR 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 AREA 43 3 4 71 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. BRYAN GROZAV 09-13-24 11:25 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORRID# 12489 O#I',WA0171300 SCOTT 9/21/2024 PAGE F OF 4 3000-345-013(R 11118) REPORT NO.! EF16910 CASE# ' 24-9478 DATE AND TIME 09/09/24 17:59 OF COLLISION s� i a � s t Y Sh�l Y It r 3 PAGE 4 OF 4