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HomeMy WebLinkAbout24-8952 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 SASE 24-8952 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 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'. 08 - 1-— 2024 1833 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ MORRIS AVE S BLOCK NO. e✓ 300 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ VV e S 3RD ST 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2063305398 0 11 30 6❑ LAST NAME ROBINSON FIRSTNAME DERRICK MIDDLE T 1 1 2 31 INITIAL STREET ❑ 419 S 2ND ST,APT 456 CITY RENTON ST WA ZIP 98057 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MM D Y' 08 1- 01 - 1974 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ PI ATFBit BRC8309 sTAr� WA urN#' 5N1A22HM8JN1471 10 Fj0 TRAILER STATE TRAILER STATE 11 0 PLATE# I I I PLATE# I FR.. To TRLR. A'RLR. 1 3 33 12 0 0 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 3 34 13 1 2018 NISS MURAN SD DAMAGE YES NO ves❑ No REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE INSURANCE CO IN EFFECT &POLICY# 9TOP CHARGE VE—LL1013 5 ❑ LEGALv res❑NO❑ CITATION# 1 o BOT 36 TOM 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068413342 16 a LAST NAME GODFREY FIRST NAME ANTHONY MIDDLE J INITIAL 17 STREET NEW ADDREs7 3229 15TH WAY SE CITY OLYMPIA ST WA ZIP 98051 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK vEs I I NOF YEs t l NOF,/ 19[—] DRIVER'S STATE WA SEX M D.Q.B. 07 11 1967 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# CMZ2482 TArE WA VIN# 41 N4AL3AP9GC244141 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GI VEH YEAR 2016 MAKE jy/$$ MODEL SQL)'/M�Q STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED By ov HyES NO 44 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGED AREA 3 4 INAEFFITY ECTNSURANCE INSU&POLICY#E CO _ 9TOP 5 VE."LE ❑ ,J� CITATION# CHARGE 25 io BOTTOM LEGALLY YES N J ' 6 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 JASON TURNER 12650 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF21537 COLLISION REPORT III III III III III 111 1591972 CASE# 24-8952 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. JASON TURNER 10-03-24 06:52 PM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 101512024 1:10:09 AM BADGE OR ID# ! 12650 ORI#' WA0171300 TIME POLICE DISPATCHED 6:37 PM TIME POLICE ARRIVED 6:46 PM PART I PAGE IT]OF 4� REPORT NO. EF21537 CASE# 24-8952 OF COLLISION 08/25/24 18:33 OF CbLLI510N NARRATIVE Unit 1 reported that they were driving southbound on Morris Ave S approaching the intersection of Morris Ave S/S 3rd ST. Unit stated that they had a green light and began making a left turn to proceed eastbound on S 3rd ST. Unit 1 stated that Unit 2 had been travling eastbound on S 3rd ST approaching Morris Ave S. Unit 1 stated that Unit 2 had a red light and failed to stop at the light, causing Unit 2 to collide into Unit 1's front passenger door/front bumper. Unit 1 reported that they were traveling eastbound on S 3rd ST approaching Morris Ave S, they stated that their light was green at the time they were proceeding through the intersection. They belived that the light had begun to change while they were in the intersection. Unit 2 had extensive damage to their front passenger panel. Unit 2 reported no injuries but the vehicle needed to be towed from the scene. Unit 1 had extensive damage to the front of their vehicle along with airbag deployment. Unit 1 stated that they had no injuries and the vehicle was able to drive under it's own power. Both parties exchanged information. Based upon both parties recollection of the incident there is not enough information to determine proximate cause of the collision. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by J. Turner 12650 on 10/03/2024 at 1844 hours. PAGE 3 OF 4 REPORT NO. EF21537 CASE# ' 24-8952 DATE AND TIME 08/25/24 18:33 OF COLLISION }t a t h t rt t� ss tl� t m §§ 4 4 s3 a t i j�4z�a r it g� t 1 i r PAGE 4 OF 4