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HomeMy WebLinkAbout24-13013 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF48626OLCERA COLLISION REPORT 1591971 CASE# 24-13013 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LOCALANG 4250 3 COUNTY RD ©DING PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s o v' 12 - 20 - 2024 1403 17 =.= S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ TALBOT RD S BLOCK NO. e 1000 .� 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ . FEET e S 8 W e RENTON VILLAGE PL OF 4 29 MOTOR PEDAL- DAM AG TSHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO 0 1 30 6 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31 INITIAL STREET ❑) CITY', ST ZIP 2 NEW ADDRESS 7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO INTERLOCKYEs No YES NO 8❑ LCEENSE# SRVERSTTATE SEX U MMDDYY' —=— 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 HELM USEET 9 CLASSY 0 NATURE OF INJURIES 2 LICENSE, 3 10� PI ATP# STATE V(N TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR TRLR 5 7 33 12 3 5 VIN# VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BUN TOWEBBv GOVT VEHICLE 1 5 13� GMC UNK PK DAMAGE YES�No ✓� ves❑ No� 34 REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 3 4 14❑ LIABILITY INSURANCE❑ NSURANCE CO IN EFFECT &POLICY# 4TOP V"" CHARGE t 5 36 Lec Ly YES❑NO❑ CITATION# 70 80TTOM 15❑ STANDING 7 e MOTOR PEDAL- PEDESTRIAN1:1 PROPERTYEl DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2063714352 16� LAST NAME BA FIRST NAME OUMOUL MIDDLE' K INITIAL 17 F1 STREET I�I ❑ 10720 SE 242ND STAG CITY' KENT ST, WA ZIP 98030 g 37 NEW ADDRESS : 1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 CDL INTERLOCKYEs No INTERLOCK YES No 19 DRIVER'S STATE WA SEX F I D.O.B. 12 24 1983 39 LICENSE# MMDDYY — HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSLATE E CLY8647 rarE WA vIN# 5TDHBRCHXMS039376 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2021 MAKE TOYT MODEL HIGHLAN STYLE UT VEHICLE TOWED TO BUN TOWED BY GOV HI 44 24 DAMAGE YES NO NO REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO GEIC04622-98.48.64 IN EFFECT &POLICY# t STOP Y 1— L,—LY YES❑ N,.I—I I CITATION# CHARGE to BOTTOM `,L 25 s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 R.ONISHI 5738 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF48626 COLLISION REPORT III III III III III 111 1591972 CASE# 24-13013 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 INJURY 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 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 Unit 2 southbound on Talbot Rd S at Renton Village PI. Unit 1 turning from northbound Talbot Rd S onto westbound Renton Village PI. Unit 2 proceeded into intersection with green light; Unit 1 turned into the left side of Unit 2, striking it on the left rear door. Unit 1 then U-turned onto Talbot Rd S and fled southbound, without any attempt to exchange information. Driver 2 Ba did not see driver one, and only knew that Unit 1 was a tan pickup with "GM" as part of the nameplate. 1 checked both traffic cameras and ALPR systems, but was unable to identify a tan pickup in the area at a time consistent with the collision. No suspect information at this time. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 12-20-24 04:31 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 12/21/2024 11:30:18 AM BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 3:07 PM TIME POLICE ARRIVED i 3:15 PM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EF48626 CASE# 24-13013 DATE AND TIME 12/20/24 14:03 OF COLLISION r Y L r,. 3 k a u t � L ~ b Lr z, +r t n " k a � Y� $ 4 � t t t?�• N Y s}}�ks s e r i tot° I1gZZ t �` L b PAGE 3 OF 3