HomeMy WebLinkAbout23-2540 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-2540 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 03 - 01 - 2023 2003 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
ROUSER WAYS BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e MAIN AVE S
0 3 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:4256473695 0 3 30
6� LAST NAME FOX FIRSTNAME ROBERTA MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 13910 SE 37TH ST CITY BELLEVUE ST WA ZIP' 980061418 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 U E 2 1 CLASS NATURE OF INJURIES z❑
3
10[1Pi ATNES# CDK1230 sTAr WAu N# 1 NXBR30E37Z920280
--- TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR 5 3 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2007 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 3 34
13 4 TOYT COROL DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ROBERTA FOX 13910 SE 37TH ST BELLEVUE WA 98006 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 INSURANCE PROGRESSIVE 958658206
IN EFFECT EFFEE CT &POLICY# 9TOP
VE—LE 5 36
LEGALLY
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 5
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:4252237562
16 2
LAST NAME HAYNES FIRST NAME PATRICIA MIDDLE I A
INITIAL
17❑ STREET NEW ADOREs7 1613 FIELD AVE NE CITY RENTON ST WA ZIP 980594246 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO INTERLOCK YEs I I NOF YEs t l NOF,/
19 LICENSE# STATE WA SEX F M D.O.B. 11 07 1949 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# BVF7842 TArE WA VIN 1 41
KNDEPCAA6M7046956 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE KIA MODEL SELTOS STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO PATRICIA HAYNES 1613 FIELD AVE NE RENTONWA98059 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSU PORGY#ECO HORACE MANN 46-83701150IN STOP 5
VEwcLE ❑ ,J� CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N`L J
s � e
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED38999
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2540
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
PM 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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 03-02-23 02:08 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 3/2/2023 9:21:18 PM
BADGE OR ID# 12650 ORI# WA0171300 TIME POLICE DISPATCHED 8:10 PM TIME POLICE ARRIVED',8:12 PM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED38999 CASE# 23-2540 OF COLLISIONO3/01/23 20:03
NARRATIVE
On 03/02/2023 at approximately 2007 hours I was working as a police officer for the city of Renton.
While working I was dispatched to a non-injury non-blocking accident at the intersection of S 3rd ST
and Main Ave S located in the city of Renton, King County, Washington.
Unit 1: Roberta N. Fox (DOB: 06/07/1957)
Vehicle: Red 2007 Toyota Corolla (WA LIC: CDK1230)
Unit 2: Patricia A. Haynes (DOB: 11/07/1949)
Vehicle: White 2021 Kia Seltos (WA LIC: BVF7842)
The accident happened as follows:
Unit 1 was stopped at a red light in lane number 1 of Main Ave S, lane number 1 is a right turn only
lane. Unit 2 was stopped at a red light in lane 2 of Main Ave S, you can make a right turn or proceed
straight in this lane. Both lanes are clearly marked by white arrows painted on the street. Lane 1 has
only a right painted arrow, while lane 2 has a straight/right painted arrow. When the light turned green
Unit 2 attempted to make a right hand turn to go east on Houser Way S, while Unit 1 attempted to go
straight and continue north on Main Ave S. While Unit 2 was making their turn, Unit 1 crossed into
Unit 2's lane of travel, causing the vehicles to collide.
Both drivers reported no injuries at the scene of the collision. Unit 1's vehicle had slight damage to
the front and rear driver's side of the vehicle, Unit 1's damage was under $1000.
Unit 2 had significant damage to the passenger side front bumper of their vehicle. Unit 2's vehicle
also had their power steering malfunction after the collision. Unit 2's damage was well above $1000.
I provided both drivers with an exchange of information.
There is no further information at this time.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by J. Turner 12650 on 03/02/2023 at 0207 hours
PAGE 3 OF 4
REPORT NO. ED38999 CASE# 23-2540 DATE AND TIME 03/01/23 20:03
OF COLLISION
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