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HomeMy WebLinkAbout24-9655 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-9655 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 2 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.. 09 - 1-- 2024 0818 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD M4000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:3302771259 0 11
30
6� LAST NAME KUPEC FIRSTNAME DUANE MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 1815 S 264TH PL CITY DES MOINES ST WA ZIP 98198 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE C30056C sTArI WAurN# 3D7MX38A28G151205
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 7 3 33
12 3 5 VIN# VIN#
i:.... FROM TO
❑ VEH.YEAR 2008 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 DODG RAM PK DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO USSA 013348601U 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062653710
16 a
LAST NAME GEOHAGEN FIRST NAME CARDETT MIDDLE JE
INITIAL
17❑ STREET ❑', 1923 REDMOND AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19[-] LICENSE# STATE WA SEX F MMDDW 10 _ 08 _ 1959 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CCF0083 TAre WA vIN# 3GNCJPS64LL309034
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY GOV HI 44
VEH YEAR 2020 MAKE CHEV MODEL TRAX LS STYLE (/T DAMAGE TOWED TOO✓ BLIN YES
NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO ALLSTATE 817871991IN 1 9TOP
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
=KI
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12598 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF16152
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9655
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 Saturday, September 14, 2024 at 0821 hours, I was dispatched to a two-vehicle collision in the
area of the Union Ave NE and NE Sunset Blvd.
The following occurred within the City of Renton, King County; Unit 1 - WA/ C30056C was being
driven by Duane Kupec and headed east in lane 2 on NE Sunset Blvd in the 4000 block. Unit 2 -
WA/CCF0083 was driving east on NE Sunset Blvd in lane 2.
Duane stated he was driving eastbound when he observed the vehicle (Unit 2) in front of him enter
the left turn lane, he anticipated passing the vehicle, when Unit 2 swerved back into lane 2 and began
to brake approximately 100 feet before the intersection, that was when the front bumper of Unit 1
struck the rear bumper area of Unit 2. Duane stated the signal was green at the time of the collision.
Cardett stated was driving home and headed east on NE Sunset Blvd. Cardett stated she normally
turns left at Union Ave NE but remembered she needed to pick up groceries at Albertsons and then
continued on NE Sunset Blvd. Cardett stated she started to brake at before the intersection because
it was red. That was when the front bumper of Unit 1 struck the rear bumper area of Unit 2 causing
significant damage to Unit 2.
Based on both statements I am unable to determine which Unit caused the collision.
Both involved sustained damage, and neither vehicle needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 09-14-24 09:52 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 9/18/2024 4:08:48 PM
BADGE OR ID# 12598 OR]# WA0171300 TIME POLICE DISPATCHED 8:29 AM TIME POLICE ARRIVED';8:Y7 AM
PART I PAGE IT]OF
REPORT NO.! EF16152 CASE# ' 24-9655 DATE AND TIME 09/14/24 08:18
OF COLLISION
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