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HomeMy WebLinkAbout24-10727 )STATE
TFcN 0 5 27i 1
Oc� RA EF24402
COLLISION REPRT 1591971
CASE# 24-10727 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL ANG 4100 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
cDUISION' 10 - 14 - 2024 1740 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
UNION AVE NE BLOCK NO. e 600 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET S 8 W e NE 6TH ST
0 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:7029858953 0 1 30
6 LAST NAME MEDICINEBIRD FIRST NAME BESSIE MIDDLE 1 1 2 31
INITIAL
STREET 12803 193RD LANE SE CITY RENTON ST WA ZIP 98059 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES No Z/ INTERLOCKYEs NO�/ YEs No,/
8� LICIENS# STATE WA SEX F MDmopyy' O6 - 07 - 1986 1 2 32
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT, 1 HELMET INJURY 6 SORE of INJURIES 2
USE ;CLASS SORENESS SHOULDER AND HEAD
10 9 LICENSE BWX5107 STATE WA VN# 5N1DR2MM6HC698863 3
tI
TRAILER STATE TRAILER ,STATE
11 0 0 PLATE# PLATE# FROM To
TRLR TRLR 7 1 33
12 0 0 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT VEHICLE
13 4 2017 HISS PATHFIN UT DAMAGE vesNo ✓ ves❑ No 1 5 34
REGISTERED OWNER INFO BESSIE MEDICINEBIRD 12803193RD LANE SE RENTON WA 98059 D:7029858953 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
❑ INSURANCE CO 2 3 4
14 LIABILITY INSURANCE�/ HORACE MANN 65000386770f01
IN EFFECT &POLICY# � 4TOP 5
VEHICLE CHARGE 7 0 80TTOM 36
Lemur yes[:]NO[:] CITATION# 5
15❑ sTnNowc s
MOTCR PEDAL YES 1/ NO PHONE
UNIT PEDESTRIAN PROPERTY D:42 VEHICLE CYCLE59069405 OWNER
16F1
LAST NAME STRANDBERG FIRST NAME TYLER MIDDLEI M
❑
17 F1 STREET' 2307 NE 4TH ST APT C201 CITY RENTON ST, WA ZIP INITIAL 98056 4 37
NEW ADDRESS❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs No INTERLOCK YES No YEs No
19 DRIVER'S STATE WA SEX M D.o.B. 12 04 1995 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS' AIRBAG'3 RESTR 4 EJECT 1 H U ET INJ RY; 1 NATURE OF INJURIES � 40
21 LICENSEPLATE# CBK7306 TATE WA VIN# JM1BK34M071728617 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2007 MAKE MAID MODEL SPEED STYLE I-/B VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO�/ YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO,2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 71556745
IN EFFECT &POLICY#
VecnLLr J—I CITATION# CHARGEeicLe
Le ❑ `
25 0M
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
RYAN KARLO RIVERA 12649 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF24402
COLLISION REPORT III III III III III 111
1591972 CASE# 24-10727
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} MEDICINEBIRD-PIPEBOY NETSEHO
(LAST,FIRST,
ADDRESS&PHONE# DOB
12803 193RD LANE SE RENTON WA 98059 SEX' M MMDDYVVv 09 - 09 - 2021
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
Q Q, 1 POS. 7 19 10 1 USE 'CLASS '1 �- --�
NAME
LAsr F RST,MIDDLE INITIAL) LOFGREN WILL►AM W
ADDRESS&PHONE# D C,B
3714 NE 24TH ST RENTON WA 98056 4256818349 SEX' M MMDDVVYv 11 09 _ 1962_
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ �✓ POS. USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M _T L----------�
MDDVYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. USE CLASS r— ----j
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 RIVERA 10-14-24 08:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY QATE
J.CHRISTIANSEN 10437 10/14/2024 9:20:08 PM
BADGE OR ID# 12649 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:43 PM TIME POLICE ARRIVED 5:51 PM
PART B 3 Do-3mx-,aR(Rtrras) PAGE 27 OF 57
EAN
REPORT NO.` EF24402 CASE# 24-10727 O OF COLLI COLLISION TIME 10/14/24 17:40
COLLI
NARRATIVE
On 10/14/2024, 1 was working uniformed patrol in a marked police car as 3R23. At approximately
1743 hours, I was dispatched to an unknown injury accident at the intersection of Union Ave NE/NE
6th St, which is located within the city limits of Renton, County of King, Washington. Dispatch advised
that at the location, there was an involved party that had called in a 2-car accident and that they were
no longer answering the call receiver's questions.
As 1 was driving to the call, dispatch advised that the call had been upgraded to an accident with
injuries.
When 1 arrived at the call location, I identified Unit 1 and Unit 2 as described above with each of the
respective occupants.
I spoke with Unit 2. He was the sole occupant of his vehicle. My conversation with him is summarized
as follows:
Unit 2 stated that he was driving southbound on Union Ave NE. As he approached NE 6th St, he saw
Unit 1 pull out in front of him from his right-hand side off of NE 6th St. Unit 2 said he tried to swerve
out of the way of Unit 1 but was unable. Unit 2's front end impacted Unit 1's rear driver's side door
panel, wheel well area, and part of the rear bumper.
Unit 2 vehicle sustained damage to the entire front area. The engine cover was broken off and 1
noticed significant dents and scratches to the front fender. 1 also noticed that the driver's airbag was
deployed.
Unit 2 driver stated he did not feel injured and was wearing his seatbelt.
I was then able to speak to Unit 1. She was the driver of her vehicle and had her young child with her
strapped in the left rear seat in a front-facing car seat. My conversation with her is summarized as
follows:
Unit 1 stated she was headed home from picking up her son from the nearby daycare. She was
headed eastbound on NE 6th St approaching Union Ave NE. It should be noted that she has a stop
sign before entering Union Ave NE. Unit 1 then began to turn northbound onto Union Ave NE and
said that Unit 2 impacted her. She claims that she did not see Unit 2.
Unit 2 vehicle sustained damage to the driver's side rear door panel, wheel well, and fender. There
were significant dents on this side of the vehicle. 1 also noticed that the driver's airbag had been
deployed.
Unit 2 stated that she had some soreness in her shoulder and head. She stated that her child in the
rear seat appeared uninjured. She also said that both of them were wearing their seatbelts. The fire
department evaluated her at the scene for her complaints of injuries.
I was also flagged down by a witness who was driving northbound on Union Ave NE from around NE
6th St. He identified himself to me as William W. Lofgren (DOB: 11/09/1962, verified via DOL photo).
My conversation with him is summarized as follows:
William stated that he was driving northbound on Union Ave NE approaching NE 6th St when he
witnessed Unit 1 begin to turn left onto Union Ave NE. He then saw that Unit 2 who was headed
southbound on Union Ave NE collide with the driver's side rear of Unit 1.
PAGE 3 OF 5
EAN
REPORT NO.` EF24402 CASE# 24-10727 O OF COLLI COLLISION TIME 10/14/24 17:40
COLLI
NARRATIVE
Both vehicles were towed by Bankers as they were undriveable.
Both parties were left under their own power from the scene.
Both parties were provided with an exchange of information before they left the scene.
Based on the circumstances described above, it appears that Unit 1 was the proximate cause of the
collision.
This report is for informational purposes to document the accident.
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
Signed: Ryan Rivera (#12649) Date & Place: 10/14/2024 @ Renton, Washington
PAGE 4 OF 5
REPORT NO. EF24402 CASE# 24-10727 DATE AND TIME i 10/14/24 17:40
OF COLLISION
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PAGE 5 OF 5