HomeMy WebLinkAbout24-11329 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF30793 170
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COLLISION REP FIT 1591971
CASE 24-11329 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
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3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 10 - 1-— 2024 1830 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE CARR RD BLOCK NO. e✓ 10545
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 82 00 FEET MILES e S ❑ W e 105TH PL
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:7074584706 0 11
30
6� LAST NAME MCDONALD FIRSTNAME PATRICK MIDDLE M 1 2 31
INITIAL
STREET ❑, 63705 ELLEN ST CITY COOS BAY ST OR ZIp, 97420 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
❑ DRIVER'S' STATE OR SEX'M MOB 10 - 31 1- 1963 1 2 32
8 LICENSE#
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 D.
H U EET 2 I INJURY CLASS 1 NATURE OF INJURIES z❑
3
10 9� PI ATE 14 023NWV STATE OR VIN#' 1 FT7W26T5GEA28759
F_ TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 5 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2016 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 3 TOWED BY GOVT.VEHICLE 34
13 4 FORD F250 TR DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO FARMERS 526154062 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063763887
16 a
LAST NAME ALLEN FIRST NAME ANTHONY MIDDLE R
INITIAL
17❑ STREET NEW ADDRESS❑' 31510 106TH PL SE APT R101 CITY AUBURN ST WA ZIP 980923085 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO
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19 DRIVER'S STATE WA SEX M I D.C.B. 11 23 _ 1975 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CLX5443 TATE 41
WA VIN# 4T1BF28621U164297 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2001 MAKE TOYT MODEL AVALON STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ATARAH PHILLIPPS 1024220TH AVE SW SEATTLE WA 98146 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO
'E""LE ❑ N,J� CITATION# CHARGE
LEG BOTTOM
ALLY YES 6
-T
25 =RSE
PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12994 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF30793
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11329
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.
JAMAAL KEARSE 10-31-24 11:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
GREGORY BILLS 12495 111112024 3:53:57 AM
BADGE OR ID# 12994 ORI# WA0171300 TIME POLICE DISPATCHED! 6:32 PM TIME POLICE ARRIVED 6:39 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EF30793 CASE# 24-11329 OF COLLISION10/31/24 18:30
NARRATIVE
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 10/31/2024, at approximately 1832 hours I was dispatched to a report of a collision at the 76-gas
station located 10545 SE Carr Rd. Dispatch advised 2 vehicle accident with one vehicle blocking the
center turn lane.
At approximately 1839 hours 1 arrived on scene. Both involved parties confirmed they had no injuries
and declined aid. I asked both drivers for their license, registration, and proof of insurance. The driver
of unit 1 provided all three documents. The driver of Unit 2 provided his license and registration but
advised he did not have insurance.
The driver of Unit 1 advised the following. He was exiting the parking lot of the 76 gas station and
attempting to turn westbound on SE Carr RD. There were cars in lane 1 of 3 and 2 of 3 eastbound on
SE Carr Rd. Both cars stopped leaving him a gap to pull out of the parking lot and turn westbound. He
did not see the car in lane 3 of 3 (the turn lane) eastbound on SE Carr Rd. As he was pulling out on to
SE Carr Rd crossing lane 1 of 3, 2 of 3 and entering lane 3 of 3. Unit 2 hit the driver side of Unit 1 with
the front driver side bumper of Unit 2. The airbags did not deploy, and Unit 1 was able to drive off to
the side of the road. He opted to get his own tow.
The driver of Unit 2 advised the following. He was driving eastbound in lane 3 of 3 (the center turn
lane) of SE Carr Rd about to turn left at the light ahead. He was going about 5mph. He saw Unit 1 pull
out in front of him from the south side of the street. He did not have enough time to stop and hit the
driver side of Unit 1 with the front driver side bumper of Unit 2. Airbags did not deploy. His car was
not able to drive and had 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.
Electronically signed by Officer J. Kearse #12994 10/31/2024 2328 Hours Renton, King County,
Washington
PAGE 3 OF 4
REPORT NO. EF30793 CASE# ' 24-11329 DATE AND TIME 10/31/24 18:30
OF COLLISION
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