HomeMy WebLinkAbout23-2820 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-2820 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 1 �2$
TRIBAL UNITS 01 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 03 - 09 - 2023 0519 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
ROUSER WAYN BLOCK NO. e✓ 1300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255725890 30
6� LAST NAME APODAC FIRSTNAME F MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 1516 S PUGET DR,APT B CITY RENTON ST WA 21p 98055 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 1 RESTR 1 EJECT 2 HELMET 5 INJURY 7 NATURE OF INJURIES z❑
USE CLASS HEAD,NECK,BACK,NON LIFE THREATENING
3
10� PI ENSE 2G7282 STATE WA uN#' 1HDlBJY171YO59985
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12❑ VIN#' VIN#
FROM
34
13❑ VEH.YEAR2001 MAKE HDMC MODEL FLSTC STYLE MC VEHICLETOWED0NOOffBLIN TSIgWgYMEYERS v�s❑ENo�
DAMAGE IILLJJII (��IV6
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
❑ ❑
14 LIABILITY INSURANCE� INSURANCE CO UNK UNK SHADE IN DAMAGED AREA 35
IN EFFECT &POLICY# 9TOP
CHARGE
V—C'
5 36
LEGALLY, YES❑NO❑ CITATION# 1 o BOTTOM
1 5❑ STAIN."' 8 6
UNIT a2 VEHICLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO OLDMET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
17❑ ESS' CITY ST ZIP ❑ 37
NEW ADDR
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOF 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❑ LICENSE TATE VIN# 41
PLATE#
42
22❑ PLATILER E# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ 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
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
=Kl
PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12598 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED41397
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2820
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 Thursday, March 9, 2023 at 0521 hours, I was dispatched to a one-vehicle collision in the area of
the 1300 Houser Way N.
The following occurred within the City of Renton, King County; Unit 1 - WA/ 2G7282 was being
driven by F Apodac and was driving from the south and was travelling northbound on Houser Way N.
F stated he was riding to work and when he crossed over the bridge, he lost traction and was unable
to correct and lost control of the motorcycle and laid it down. The temperature was approximately 30-
degrees Fahrenheit, and I observed frost and ice on some parts of the roadway. No other vehicles
were involved. F had no signs of impairment. F was transported to the hospital for further evaluation.
The motorcycle sustained damage and needed to be towed by Gene Meyers Towing.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 03-09-23 06:39 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 3/11/2023 12:25:53 AM
BADGE OR ID# 12598 ORI# WA0171300 TIME POLICE DISPATCHED 5:21 AM TIME POLICE ARRIVED 5:22 AM
PART I PAGE IT]OF
REPORT NO. ED41397 CASE# 23-2820 DATE AND TIME 03/09/23 05:19
OF COLLISION
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