HomeMy WebLinkAbout25-80823 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-80823 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F E:RUN
AOENC 3
HIT IT&RUN ✓ CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 5 2$
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES ✓ CITY# ❑
cawsloN 12 - 18 - 2025 0719 17 ❑. N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SHATTUCKAVES
0 1 29
UNIT MOTOR
Z PEDAL-
CYCLE ❑ YESA,GEE NHORESHOLD MET PHONE 0 4 30
6� LAST NAME DOLL FIRSTNAME JENNIFER MIDDLE E 1 2 31
INITIAL
STREET ❑, 509 STEVENS AVE NW CITY RENTON ST WA 2jp, 980573429 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
✓ I iNTERLOCKYEs No NTERLOCKYEs NO✓ YES R No
8❑ LRIIVERS STATE WA SEX'F MID
.O B 01 1— 11 — 1979 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET 9 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BXU2559 sTAr� WAVrN# JT3HN86R6Y0268107
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE IM
ODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 $ 34
13 2000 TOYT 4RUNNE UT DAMAGE vE8 0NO �LII� RS TOWING ves❑ No✓
REGISTERED OWNER INFO JENNIFER DOLL 11330 E RIVERSIDE DR UNIT 7 BOTHELL WA 98011 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO NATIONAL GENERAL 2011588537 3 4
IN EFFECT &POLICY# 9TOP
vewCLE CHARGE 5 36
LEcnLLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN.F- 8 6
UNIT VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER
RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY RENTON ST ZIP 4
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NOR INTERLOCK YEs❑NOF YEs❑NOF
19 LLIICENS RIVER# STATE SEX U MMODYY —�_ ❑ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
❑21❑ TArE LICENSE VIN# 41
1
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE pLATE#ILER STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE CHRY MODEL PT STYLE SW VEHICLE TOWED TO BLIN TOWEDev GOS HI �44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO UNKNOWN RENTON VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGD
VEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N`LJ
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JESSE VANDERHOEK 11631 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EG60294
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80823
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HEFFERNAN CHARLES
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2065182613 SEX' M MMDDYYYY OS - 03 - 1952
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET NJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYVYV
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'
Vehicle #1 was traveling westbound on Airport Way, approaching Shattuck Ave S. Vehicle #2 was
traveling eastbound on Airport Way, approaching Shattuck Ave S. A witness advised vehicle #2 had a
green traffic signal as it proceeded eastbound through the intersection of Airport Way at Shattuck Ave
S. At this same time, vehicle #1 turned left onto Shattuck Ave S directly in front of vehicle #2, causing
the front right corner of vehicle 2 to collide with the rear bumper of vehicle #1. Vehicle #2 immediately
pulled over to the side of the road. Vehicle #1 continued southbound on Shattuck Ave S, and did not
stop to exchange information with the other driver. A witness observed the collision, and then
followed the suspect vehicle (vehicle #1) until it came to a stop at the 7-Eleven, located at 12848
Martin Luther King Jr Way S, Seattle. The witness described the suspect vehicle as a beige colored
Chrysler PT Cruiser, unknown license plate number, with the rear bumper hanging off dragging on
the roadway. KCSO attempted to locate the suspect vehicle at 7-Eleven, but it was gone upon their
arrival. There was no description of the suspect driver. The suspect is not identified at this time.
Based on the totality of the circumstances, it appears the driver of vehicle #1 was the proximate
cause of this collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 12-18-25 11:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 12/18/2025 1:29:41 PM
BADGE OR ID# 11631 OR]# WA0171300 TIME POLICE DISPATCHED! 7i28 AM TIME POLICE ARRIVED;7:31 AM
PART I PAGE IT]OF 3�
REPORT NO. EG60294 CASE# ' 25-80823 DATE AND TIME 12/18/25 07:19
OF COLLISION
J z
a
J
J
1
i
x
� r
1.
r t
5h�.
�J
„3
ti
§� f
JJ
sx.
}
7
p �
s
t
y
PAGE 3 OF 3