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HomeMy WebLinkAbout24-11154 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-11154 z INTERSTATE ❑ CITY STREET ❑ FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4300 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 28 TRIBAL UNITS 02 STRUCK' FENCE RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cowsloN 10 - 1-- 2024 0904 17 ❑.❑ S 8 W e IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ TALBOT RD S BLOCK NO. e✓ 4550 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5 20 00 FEET MILES e S ❑ W e S 45TH PL 0 2 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2062007973 30 6� LAST NAME GOURAS FIRSTNAME STAVRO MIDDLE 1 1 2 31 INITIAL STREET ❑, 4550 TALBOT RD S,UNIT 411 CITY RENTON ST I WA 2jp, 98055 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑ 3 10❑ P1 ENSEATE 14 AFC9939 sTAr W/a v N# WDDHF5GB86A456272 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FRom ro TRLR. A'RLR 1 7 33 12❑ VIN#' VIN#. 2011 NIERZ E350 CQ ❑ RO�34 ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13 9 DAMAGE YES NO �/ YES HI REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE INSURANCE CO ALLSTATE 820 156 0624 4 IN EFFECT &SUR N# TOPVEHCLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT vEHICLE ❑ cvcLE ❑ ❑ OWNER ❑ YEs No ,/ D:4255771718 16❑ LAST NAME WEATHERLY FIRST NAME INN MIDDLE INITIAL 17 STREET 1LBOT RD S CITY' RENTON ST WA ZIP 98055 37 NEW ADDREs�' 4550 TA 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 LLIICENS # STATE SEX X MMDDYY —�_ 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ ❑21❑ LICENSE TArE VIN# 41 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 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5 VE."Le ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N J 25 s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 E.S/MS 12225 WA0171300 PART A PAGE 01 OF 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF36889 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11154 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. E.SIMS 10-27-24 10:37 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT G.BARFIELD 6476 1111812024 3:24:37 PM BADGE OR ID# 12225 OR]# WA0171300 TIME POLICE DISPATCHED; 9:06 AM TIME POLICE ARRIVED',9:11 AM PART I PAGE IT]OF 4� REPORT NO. EF36889 CASE# 24-11154 OF COLLISION 10/27/24 09:04 OF CbLLI510N NARRATIVE Renton Case #24-11154 On 10/27/2024 at approximately 0906 hours, I was dispatched to Weatherly Inn, located at 4550 Talbot RD S, in the City of Renton, King County, Washington, for an injury collision in the parking lot. My involvement in this case was captured on my department-issued Axon body camera. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. At the time of this call, I was in a full police uniform equipped with a Renton Police badge and police patches. Upon arrival I observed a silver 2011 Mercedes E350, bearing WA license plate #AFC9939, in the parking lot. The vehicle had hit a fence and had significant damage to the front of the vehicle. The driver side airbags had deployed, and the fence only had minor scratches on it. I located the owner/driver of the vehicle inside the location and identified him via his WADL as Stavro Gouras (DOB 03/11/1939). Gouras told me he was not injured and declined aid. Gouras told me he was driving south through the parking lot when he attempted to drive around a vehicle that was stopped in the roadway and hit the fence. Gouras requested a tow for the vehicle and provided me with his insurance information. I took photos of the vehicle and damage and provided Gouras with a business card with the case number on it. A business card was also provided to the supervisor who was at the location for the damage to the fence. Once the tow truck arrived, I left the scene. This ends my report. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by E. Sims on 10/27/2024 at 1035 hours, in the City of Renton, WA. PAGE 3 OF 4 REPORT NO. EF36889 CASE# 24-11154 DATE AND TIME 10/27/24 09:04 OF COLLISION � � x Alt t� z s 4 (S i �{ Y P S{F r= w �y �r 2� a PAGE 4 OF 4