HomeMy WebLinkAbout24-12586 ("7—
STATE.w,-" .:.. TFFiNCERA �I I ��� III I I Iil I I�I1 II{ II I 1 27c .
COLLISION REP F 1591971
FIRE
CASE# 24-12586 2
INTERSTATE CITY STREET
RESULTED ❑
1 2 S OLEN STATE ROUTE OTHER VFTHICI F LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 7S TOTAL#t7F STRUCK OBJECT 1 28
01 FIRE HYDRANT
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
LOLL s ON 12 - 07 - 1 1526 17 �. e W e OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
SUNSET BLVD N 8✓ .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
6❑ 500 00 FEET e✓ S e W 8 N 3RD ST
OF11
29
k, M0T6R PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 0 VEHICLE CYCLE'. YES NO D:4252267256 30
6 LAST NAME BARBER FIRST NAME MICHAEL MIDDLE T 1 2 31
INITIAL
STREET E:1' 2601 MILL AVE S CITY RENTON WA
NEW ADDRESS 57 ZIP 98055 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No,/ INTERLOCKYEs NOW YES NO,/
$❑ OB
LICENSE# STATE WA SEX'M MMDDW 11 - 28 - 1955 32
9 F] ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U5 E7 2 CLASS 1 NATURE OF INJURIES 2
10❑ LICENSte BNJ8177 STATE
WA WIN#' 3PCAJ5M36KF110235 3
11 3 5 PLATE# STATE PLATE# STATE ROM To
TRLR TRLR. 1 5 33
12 VIN# VIN#
: FROM TO
13 4 VEH.YEAR2019 MAKE INFI MODEL Q50 STYLE SD VEHICLETOWEED2 OnfBLIN 9NED.4LRS GOVT,VENOCL✓ m34
❑ DAMAGE II1I._IIII tlAlVt(t ccJllu—'II
REGISTERED OWNER INFO M/CHAFE BARBER 2601 MILL AVES RENTON WA 98055 D:4252267256 VEHICLE NO. 1 ❑
SHADE 1N DAMAGED AREA 35
14❑ LIABILITY INSURANCE NSURANCECO AMERICAN FAMILY CONNECTAB00170610 4
IN EFFECT &POLICY# STOP
VEHICLE CHARGE 5 ❑ 36
EGALI v YES❑NO❑ CITATION# 10 BOTTOM
15❑ sTAnowG 6
MOTOi2 PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 PEDESTRIAN YES NO
VEHICLE CYCLE OWNER
16❑
LA5T NAME FIRST NAME MIDDLE
INITIAL
17
STREET
CITY' ST' ZIP 37
❑ {I��I
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YES No INTERLOCK YES NO YES f No
19❑ LICENSE# S1A7E SEX MMDDYY -=_ 3❑ 39
20❑ ON DUTY❑ STATUS AIRBAG RESTR EJECT HELMET INJURY NnruREOFINJURIES ❑ 40
USE CLASS
21❑ LICENSE PLATE# TATE' VIN# 41
❑ 42
22 [TRAILER TRAILER
PLATE# STATE PLATE S7A7E
23 TRLR 43
RLR
VIN# IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWEDfUf TO BLIN TOWED BY GO HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
LIABILITY INSURANCE INSURANCE CO E 3 4
IN EFFECT &POLICY# t GQ
VEHICLE ❑ .1-1 CITATION# CHARGE
25
LEGALLY YES NC[:]
B e
7KE1'N
'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
PETERSON 12808 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF46247
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12586
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST FIRST,MIDDLE INITIAL) MANUEL ATCHINSON L
ADDRESS&PHONE#
18512 4TH ST E LAKE TAPPS WA 98391 SEXi M MMD.O B.Y 07 - 18 - 1955
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z ❑' 1 POS. 3 2 4 1 USE 1 2 CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS R PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
: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
I was dispatched to a collision on 12/07/24 at 1535 hours at 219 Sunset Blvd N, in city Renton, King
County WA.
Unit 1 BNJ8177 Driver: Michael T. Barber (DOB 11/28/1955)
Unit 1 was driving South on Sunset Blvd N when he stated that someone cut him off, he then swerved
and ended up into the fire hydrant. He stated it happen quick was not sure of why he ended up on the
curb and into the hydrant.
Both driver and passenger stated no injuries.
The driver were given a case# as reference.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 12/07/2024, 1822 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 12-07-24 06:23 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 12/15/2024 7:50:26 PM
BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:35 PM TIME POLICE ARRIVED i 3:39 PM
PART B 3000-345.160(R1Vt8) PAGE 0 OF F3
REPORT NO. EF46247 CASE# 24-12586 DATE AND TIME 12/07/2415:26
OF COLLISION
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