HomeMy WebLinkAbout25-4553 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-4553 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT ❑2$
TRIBAL UNITS 01 STRUCK' M/SC OBJECT OR DEBRIS ON ROAD
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GowsloN 05 - 1-- 2025 1740 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ OF GARDEN AVE N
2 0 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
6� LAST NAME MORRILL FIRSTNAME VINCENT MIDDLE B 1 1 2 31
INITIAL
STREET ❑ 247 PELLYAVE N CITY RENTON ST I WA ZIP 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
�/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 09 — 29 — 1960 32
9 ON DUTY❑ STATUS AIRBAG 1 RESTR 13 EJECT 2 HELMET 5 INJURY 5 NATURE OF INJURIES z❑
USE CLASS CONCUSSION,CUT TO HEAD UNKNOW OTHER.
3
10❑ Pl ATNFS# 3D2103 STATE WA VIN#' 1HDlBX5177YO70789
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ VIN#j VIN#
FROM
34
13❑ VEH.YEAR 2007 MAKE HD MODEL FlSTF STYLE MT VEHICLE TOWED No pLSSBLIN TQ yEq.BLRs YES[:] No
DAMAGE ILJI tSA1Vi�6
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILIT INSURANCE❑ INSURANCE CO UNKNOWN UNKNOWN
IN EFFECT &POLICY# 9TOP
VEI" CHARGE 1 o BOTTOM 36
LEGAL
Lv res❑NO❑ CITATION#
15❑ STANDING 8 7 6
�UITN 02 VE ICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNERRTY ❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLEITIAL
IN
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY —❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 s � e
7PETERSON
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF98481
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4553
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SHINOHARA LEE E
(LAST FIRST,
ADDRESS&PHONE# D O.B.
1500 S 18TH ST APT H2O1 RENTON WA 98055 2066170648 SEX M MMDDYyry 02 - 12 - 1957
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ [Z; POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEXI MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
I was dispatched to a collision on 05/23/25 at 1832 hours on Airport Way and Lake Ave S, in city
Renton, King County WA.
Unit 1 3D2103 Driver: Vincent B. Morrill (DOB 09/29/1960)
Unit 1 spoke to me and did not know what happen and was unsure of where he was and did not
realize that he was in an accident. A witness ridding behind him gave the following information. Unit 1
was traveling West on Bronson Way N in lane 2. Unit 1 when approaching Garden Ave N and
Bronson Way N Unit 1 switched into lane 1 to pass a vehicle that was in lane 2 and then laid his bike
down and slid all the way across Garden Ave N onto the curb.
Unit 1 was seen by Renton Fire on scene and seemed to have a concussion and no memory of the
accident. Unit 1 also had multiple laceration to the head and road rash on stomach. Unit 1 was
transported to Harborview Hospital for further treatment.
Unit 1's motorcycle was impounded, and Unit 1 got a copy of the impound form.
Pictures were taken and uploaded to evidence.
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: 05/25/2025, 0020 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 05-25-25 12:22 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 6/6/2025 8:46:14 PM
BADGE OR ID# ! 1Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 5:42 PM TIME POLICE ARRIVED',5:45 PM
PART I PAGE IT]OF 3�
REPORT NO. EF98481 CASE# ' 25-4553 DATE AND TIME 05/24/25 17:40
OF COLLISION
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