HomeMy WebLinkAbout24-12125 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF38808oc� RA COLLISION REPORT 1591971 CASE# 24-12125 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ VEHICLE ❑ LOCALANG 3 HIT&RUN C©DIN6 COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT o 7 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCLson' 11 - 22 - 2024 2040 17 =.= S 8 W e IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SUNSET BLVD NE BLOCK NO. ❑ MILE POST e 4a ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 1.� FEET e S 8 W e BRONSONWAYNE 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:3605070542 0 1 30 6❑ LAST NAME PESICKA FIRST NAME SHANNON MIDDLE R 1 2 31 INITIAL STREET ❑ 904 N 5TH ST CITY; RENTON ST WA ZIP; 98057 2 NEW ADDRESS 7❑ CDL IGN(TI{DN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO INTERLOCKVEs NO YES F NO 8 DRIVERCENS # STATE WA SEXI M MMDDYY' 09 - 17 - 1970 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 [NATURE of INJURES 2 LICENSE, C09731K STATE WA VIN#; 1FT8W3BT0HEB17764 3 10 Fq I as ATP rt TRAILER 11 0 0 STATE TRAILER STATE ROM To PLATE# PLATE# TRLR zRLR. 1 1 5 33 12 0 0 VIN#' VIN# FROM TO VEH.YEAR ZOI7 MAKE FORD MODEL F350 STYLE VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 $ 34 13� DAMAGE YES II_II NO `/ YESII_I) NO REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 3 LIABILITY INSURANCE INSURANCE CO 2 3 14 FIRST NATIONAL H2215547 IN EFFECT &POLICY# i 4TOP VEHICLE CHARGE 36 Lemur yes❑NO❑ CITATION# 80TTOM 15❑ sTnNowc s y MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES�/ NO D:4254588705 16� LAST NAME ABSHER FIRST NAME ' ADAM MIDDLE D INITIAL 17 F1 STREET ❑ ❑ 1406 R/DDELL AVE NE CITY ORTING ST, WA ZIP 98360 q 37 NEW ADDRESS 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYES No INTERLOCK YES R NO YES NO 19 DRIVER'S STATE WA SEX M I D.O e. 01 01 1975 39 LICENSE# MMDDYY - 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U ET 2 INJURY 1 NATURE OF INJURIES 40 21 LICENSEPLATE# 259XSE rare WA vIN# 2C3KA53G77H828357 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR r RLR 43 UIN#. 'IN# TOWED BY GOV HI 44 VEH.YEAR 2007 MAKE CHRY MODEL 300 STYLE SD VEHICLE TOWED✓ No BLIN BANKERS ves No�/ 24 REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO.2 SHADFjy DAMAGED AREA 3 4 LIABILITY INSURANCE INSURANCE CO GEICO 6152081201 IN EFFECT &POLICY# 9TOP vewae ❑ ,J—I CITATION# CHARGE t080TTOM EEGnEEY YES N 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 BLAKE BOWIE 12105 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF38808 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12125 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CIASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE On 11-22-2024 at 2043 hours I was dispatched to the intersection of Sunset Blvd NE / Bronson Way NE, in the City of Renton, County of King, State of Washington, for a collision. While enroute, dispatch advised that there was a non-injury two vehicle collision at the above address. The collision was between a black 2017 Ford F350 (WA LIC: C09731 K) and a blue 2007 Chrysler 300 (WA LIC: 259XSE). Upon arrival, I contacted the driver of the Ford, Shannon R. Pesicka (DOB: 09-17-1970). Shannon stated he was driving southbound on Susnet Blvd NE and as he went around the bend a white van was in his lane coming straight at him. Shannon slammed on his brakes in order to not hit the van head on. When he hit his brakes he was rearended by a Chrysler 300. The white van continued to drive north and never stopped. Shannon did not complain of any injuries. contacted the driver of the Chrysler, Adam D. Absher (DOB: 01-01-1975), next to his vehicle. Adam stated he was driving southbound behind the Ford and a white van was in their lane coming at them. Adam braked but he was unable to stop in time and rearended the Ford. Adam did not complain of any injuries. Adam's vehicle was towed by Bankers Towing as it was not drivable. I provided both drivers with an info exchange form which contained the case number for their records. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electrically signed by Officer B. Bowie / 12105 on 11-22-2024 at 2146 hours in the City of Renton. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BLAKE BOWIE 11-22-24 09:54 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVEQ BY DATE DESIRES SCOTT 10272 11/23/2024 9:52:19 AM BADGE OR ID# 12105 ORI# WA0171300 TIME POLICE DISPATCHED 1 8:40 Pry] TIME POLICE ARRIVED i 8:49 PM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EF38808 CASE# 24-12125 DATE AND TIME 11/22/2420:40 OF COLLISION ti c 7 PAGE 3 OF 3