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HomeMy WebLinkAbout24-9878 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-ss78 z RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F E: LOCAL AGENCI 4150 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� TOTAL#OF OBJECT 1 �2$ TRIBAL UNITS 01 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ Ct ELISION' 09 - 1-- 2024 2200 17 ❑.❑ S 8 W e IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ AIRPORT WAYS BLOCK NO. e✓ 200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 1 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES No D:2063754973 30 6� LAST NAME BAILEY FIRSTNAME TAHJ MIDDLE E 1 1 2 31 INITIAL STREET ❑ 303 FACTORY AVE N APT#4 CITy RENTON ST WA 2jp, 98057 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT 9 H U SE 1 1 INJURY -, [NATURE OF INJURIES 9 CLASS 7 I COMPLAINT OF ARM PAIN z❑ 3 10� Pi aT�B� CGD0193 sTATe WAurN# JFIVA1E62H9826562 TRAILER STATE PLATE STATE 11 0 0 PLATE# PLATE# FRom ro TRLR. TRLR 7 3 33 12❑ VIN#' VIN#'. 2 SUBA INFIX STYLE ❑ R0�34 ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 017 13 4 DAMAGE YES NO �/ YES NO REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 IN EFFECT &POLICY# 9TOP VEwcLE CHARGE 5 36 LECALLv Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STAIN,DIING 8 7 6 UNIT U2 VEHIMOTCCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES ❑ DYES NO OLD MET PHONE 16❑ LAST NAME FIRST NAME MIDDLE INITIAL STREET CITY' ST ZIP 37 17❑ NEW ADDRES7 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIRIVEWSTICENS # STATE SEX MMDDYY 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ TATE 41 IN#LICENSE V 1 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY Gov HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE #E CO IN EFFECT &PO 1 9TOP 5 VE"LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N J 25 s 6 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 RYAN KARLO RIVERA 12649 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF16868 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9878 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 PM 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' 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. RYAN KARLO R/VERA 09-20-24 11:17 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT J.CHRISTIANSEN 10437 9/21/2024 12:12:44 AM BADGE OR ID# 12649 ORI# WA0171300 TIME POLICE DISPATCHED 10:10 PM TIME POLICE ARRIVED',10:12 PM PART I PAGE IT]OF 4� REPORT NO. EF16868 CASE# 24-9878 OF COLLISION 09/20/24 22:00 OF CbLLI510N NARRATIVE On 09/20/2024, 1 was working uniformed patrol in a marked police car as 3R23. At approximately 2210 hours, I was dispatched to an injury accident at the Shell service station at 401 Park Ave N, which is located within the city limits of Renton, County of King, Washington. Dispatch advised that the caller was the victim of a hit-and-run accident approximately 5 minutes ago. The caller also mentioned that the other involved suspect vehicle was gone from the location and that he was complaining of arm pain. When I arrived at the dispatch location, I identified Unit 1 and the sole driver as listed. I located the driver involved in this incident as he was walking outside of the Shell station store. My conversation with him is summarized as follows: The driver of Unit 1 stated that the actual accident occurred around possibly the 100-300 block of Airport Way, Renton. Unit 1 said he was recently pulled over by Renton PD earlier in the evening and was driving eastbound from around the location where he was pulled over. Unit 1 stated he was traveling eastbound on Airport Way in an unspecified lane when an unknown vehicle sideswiped him on his passenger side. Unit 1 then said he may have hit some road barriers in the area after being sideswiped. The driver of Unit 1 was unable to provide any detailed description of the other involved vehicle. The driver of Unit 1 also stated he was overwhelmed and drove to the Shell station to call the police, his girlfriend, and other family members. As I spoke to the driver of Unit 1, he was crying and obviously overwhelmed. His story about the details of the accident did not make a lot of sense. He had trouble staying on one topic and focused on trying to contact his girlfriend. He was unable to provide me with the registration for his vehicle or insurance at this time. He was also unable to provide me with any further details regarding the accident that occurred. I observed Unit 1 from the outside and saw that there were fresh dents and scrapes along the passenger side rear door panel and front passenger wheel well area. The diver of Unit 1 was evaluated for his complaint of arm pain and transported to the hospital from the scene. Other family members arrived and drove his vehicle away from the Shell station under its own power. At this time, the suspect's identity is unknown. This concludes my report. I certify (declare)under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Signature: Ryan Rivera (#12649) Date and Place: 09/20/2024 @ Renton, WA PAGE 3 OF 4 REPORT NO.! EF16868 CASE# 24-9878 DATE AND TIME 09/20/24 22:00 OF COLLISION PAGE 4 OF 4