HomeMy WebLinkAbout22-13830 ITFF' "POLCERA II I !�� I III I III I IIII III II I . B 27c
COLLISION REP FIT 1591971
CASE 22-13830 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4100 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'. 12 - 1-- 2022 1417 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OFHOUSER WAYN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2539705104 0 11
30
6� LAST NAME WOLLASTON FIRSTNAME BRIAN MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 515 S 323RD PL APT 16H CITY FEDERAL WAY ST WA Zjp, 980035869 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BGH3021 sTArI WAurN# KNADH4A32B6948438
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 ] 34
13 1 2011 KIA RlO DAMAGE YES NO �MEYER YES❑ No✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE U INSURANCE CO FARMERS 195119485 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
EGALLY YES No CITATION# 2A0561211 VEH ENTER INTERSEC STEADY RED o eorrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
VEHICLE
UNIT 02 CYCLE riWNPR
❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ NO D:2069926957
16 a
LAST NAME GEBREMEDHIN FIRST NAME HENOCK MIDDLE y
INITIAL
17❑ STREET ❑', 4108 NE 5TH ST CITY RENTON ST WA ZIP 980594708 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK yEEsl I I NOF YEs t l NO�
19[ DRIVERS# STATE WA SEX M M.C.B. 01 1 26 _ 1965 39
HELMET {NJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE BIV5150 TAre WA vIN# JT2BF28K9X0153455
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 1999 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES�/ NO GENE MEYERS YES NO
REGISTERED OWNER INFO HENOCK GEBREMEDHIN 4108 NE 5TH ST RENTON WA 98059 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO STATEFARM 375 8104-E20-47AIN 1 9TOP 5
VEHICLE ❑ — CITATION# CHARGE i o BOTTOM
LLY YES NC[:] 6
25 LEGAOFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED20303
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13830
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CLEM PAGE J
(LAST FIRST,
ADDRESS&PHONE#
1124 HARR/NGTON AVE NE#104 RENTON WA 98056 2538839408 SEXi F MMDDvyrv1990
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER ZWITNESS❑',UNIT# j 1 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 17 POSSIBLE NECK INJURY
NAME
(LAST,FIRST,MIDDLE INITIAL) RICKENBACH KELLYA
ADDRESS&PHONE# DOB
258 CHELAN AVE NE RENTON WA 98059 2063218239 SEX' F MMDDvvvv 09 _ 01 _ 1977
PASSENGER WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling northbound on Houser Way N approaching the traffic signal and intersection with
Bronson Way N. Unit 2 was traveling westbound on Bronson Way N approaching the traffic signal
and intersection with Houser Way N. Houser Way N is a northbound only one-way street with the
right three lanes being right turn only, and the left lane, in which Unit 1 occupied, is designated for
straight ahead or left turns and has a designated traffic signal. Driver 1 states that he saw a green
light switch to yellow but it is possible this was for the right turn lanes and not his lane. Driver 2
advised he had a green light and witness, who was traveling eastbound, stated the light had just
turned green for east/west lanes of travel. Based on these statements, it appears as though Unit 1
entered the intersection against the red light. Unit 1 entered the intersection and the front end of Unit
1 struck the front driver's side corner of Unit 2 causing heavy damage. Passenger 1 complained of
neck and back injury and was transported to Harborview Medical Center for treatment. Driver 1 and
Driver 2 stated they were uninjured. Both vehicles towed by Gene Meyer.
Driver 1 was cited for entering an intersection against a solid red circle (red light) which was the
proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 12-28-22 03:11 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 12/30/2022 1:43:08 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED Y:99 PSI TIME POLICE ARRIVED',2:21 PM
PART I PAGE 2�OF❑
REPORT NO. ED20303 CASE# ' 22-13830 DATE AND TIME 12/28/22 14:17
OF COLLISION
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a
Bronson Way N
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