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COLLISION REP FIT 1591971
CASE 23-1517 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 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#
cowsloN 02 - 1-- 2023 0940 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW SUNSET BLVD BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ OF HARDIEAVESW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:4254207976 0 81
30
6� LAST NAME ACUNA FIRSTNAME DANIELA MIDDLE N 1 1 2 31
INITIAL
STREET ❑1 12625 58TH AVE SE CITY SNOHOMISH ST WA 2jp, 982968963 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICENSE WA STATE Wq SEX
F MM DAY' 06 — 05 — 1998 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
10[1P1 ATNES# CEK5590 sTAr WAu N# JF1 SF6550XH713755
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 3 9 34
13 2 1999 SUBA FOREST DAMAGE vEs 0NO agW�MEYER ves❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO AMERICAN FAMILY 41082-50509.90 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2532310924
16 a
LAST NAME TATE FIRST NAME JOHNNIE MIDDLE A
INITIAL
17❑ STREET ❑', 11315 US HIGHWAY 12 CITY RANDLE ST WA ZIP 983779107 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES
t l NOF,/
19[ LICENSE# STATE WA SEX M M DDY
D.C.B.
07 1 14 1959 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE 2912748 TAre IN VIN# 1XKYDK9X5LJ416308
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE KEN MODEL SEMI STYLE SE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO TRANSPORT MARTIN 10364 BENNETT PARKWAY ZIONSVILLE IN 46077 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU&PORGY#E CO MARTEN TRANSPORTXSAH1076225A 1 9TOP
IN EFFECT
'E""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES N�
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.STEED 8770 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED31553
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1517
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 02/06/23 at about 0955 hrs I arrived at SW Sunset Blvd and Hardie Ave SW for a non-injury
blocking collision, in the City of Renton, County of King, and State of Washington. Both drivers were
identified by their WADL. Unit#1 was stopped behind a semi in the inside WB lane of SW Sunset
Blvd at a red light for Hardie Ave SW. Driver#1 said she thought the light turned green when the turn
lane next to her started moving. She started moving as well and rear-ended Unit#2 who remained
stopped at the red light. The semi, Unit#2, did not have a trailer attached. There was minimal
damage caused to the Unit#2 but significant damage to Unit#1. Gene Meyer Towing towed the Unit
#1 from the roadway.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed by Officer Steed on 02/06/23 1028 hrs, Renton Washington
Cassidy Steed/8770
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.STEED 02-06-23 10:34 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
QUINT TIBEAU 07691 2/6/2023 11:24:14 AM
BADGE OR ID# 8770 OR]# WA0171300 TIME POLICE DISPATCHED! 9:44 AM TIME POLICE ARRIVED:9:54 AM
FART I PAGE IT]OF 3�
REPORT NO. ED31553 CASE# 23-1517 DATE AND TIME 02/06/23 09:40
OF COLLISION
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