HomeMy WebLinkAbout24-12247 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-12247 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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.. 11 - 1-— 2024 1253 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV a SUNSET BLD NE
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066834927 0 11
30
6� LAST NAME GOETZENDANNER FIRSTNAME TASHEMA MIDDLE A 1 2 31
INITIAL
STREET ❑ 1190 UNION AVE NE APT Al2 APT CITY RENTON ST WA 2jp, 980594429 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 . EJECT 1 H USE 2 CLASS 7 [NATURE OF INJURIES HITHER HEAD ON VISOR z❑
3
10❑ P1 ATNES# BLS0925 sTAT WA v N# JTNBB46KX73013846
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM ro
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR 2007 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 TOYT CAMRY SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO TASHEMA GOETZENDANNER 1190 UNION AVE NE APTAI2 RENTON WA 98059 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO FARMERS 206401917.0 3 4
IN EFFECT &POLICY# 9TOP
VEHICLe 1 36
LEGALLY
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN
16 a PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2539812200
LAST NAME CASO FIRST NAME ALEJANDRO MIDDLE D
INITIAL
17❑ NEW ADDRE— 3002 B STREET ST SE APT A CITY AUBURN ST WA ZIP 98002 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/
19[—] LDI IVERIS STATE WA SEX M M D.O.B. 02 _ 26 _ 1994 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HE 2 INJURY 7 NATURE of INJURIES ❑ 40
USE CLASS SORELEFTARM
❑ILICENSE 21❑ PLATE# 'AQE8009 TATE 41
WA VIN1 1C4NJRBB1ED661512 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2014 MAKE JEEP MODEL PATRIOT STYLE VT VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ALEJANDRO CASO 3002 B STSEAPTA AUBURN WA 98002 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 961028355IN 5VEHICLE ❑ CITATION# CHARGE
25 GQ
LEGALLY YES N`E]
s � a
7ECHANG
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF40977
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12247
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
POS. 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'
On 11-26-2024 at about 1257 hours, I was sent to a collision at the intersection of NE Sunset Blvd
and Sunset Blvd NE, in the City of Renton, King County, Washington.
I saw unit 1 had damage to the front driver side and unit 2 had damage to the front passenger side.
Upon arrival I spoke with the driver of unit 2. He said he was driving eastbound on NE Sunset Blvd in
lane 2 and at the intersection, unit 1 swerved into him to avoid another vehicle. Unit 1 was in lane 1.
He also said they had a green light.
I saw the driver of unit 1 was trying to listen to what unit 2 was saying.
I spoke with the driver of unit 1 and she said there was a medical emergency but did not elaborate.
She told me that unit 2 was headed westbound and was oncoming. I told her not to repeat what the
other driver said. In the end she said she did not remember what happened.
Both drivers had valid WADL and insurance.
Unit 1 complained about a head injury from her sun visor.
Driver of unit 1's unsafe lane change is a contributing factor in the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 11-26-24 06:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 1112912024 2:13:12 PM
BADGE OR ID# 10065 OR]# ': WA0171300 TIME POLICE DISPATCHED 12:57 PM TIME POLICE ARRIVED',4:02 Pry
PART I PAGE IT]OF 3�
REPORT NO. EF40977 CASE# ' 24-12247 DATE AND TIME 11/26/24 12:53
OF COLLISION
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