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Home My WebLink About23-2898 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c COLLISION REP FIT 1591971 ❑ ❑ FIRE ❑ CASE$# 23-2898 2 673 INTERSTATE CITY STREET ✓ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT i TRIBAL UNITS 03 STRUCK' FENCE RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CowsloN 03 - 11 - 2023 1304 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ ANACORTES AVE NE BLOCK ST e✓ MILEPOST 1400 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 75 00 FMILES N EET e S B W e NE SUNSET BLVD 1 5 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El �/No D:2537096418 1 4 30 6� LAST NAME FAIRBURN FIRSTNAME CLIFFORD MIDDLE E 1 1 2 31 INITIAL STREET ❑, 4400 NE SUNSET BLVD APT 21 CITy RENTON ST WA ZIP 980594034 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 ✓ I INTERLOCK YES[:]No NTERLOCKYEs NO✓ YES R No 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ P1 aT�S� BfV5102 sTArr WAurN# JNKAY21 DOVM502371 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR. 0 33 12 0 0 VIN#j VIN#' RomM TO 34 13❑ VEH.YEAR 1997 MAKE fNFf MODEL J30 STYLE SD VEHICLE TOWED 0NOO ffBLIN TSIgWgYMEYERS vOs❑ENO✓ DAMAGE IILLJJII (��IV6 REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILI INSURANCE INSURANCE CO STATE FARM 1627317EO247A <53��, 4 IN EFFECT &POLICY#VEHICLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# 15❑ STAIN.D'ING 7 UNIT VE IMOTOOR Z CYCLE PEDAL- ❑ PEDESTRIAN ❑ PROPERTY ❑ DYES✓ NO OLD MET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY RENTON ST ZIP 4 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIICENS # STATE SEX U MMDDYY 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑ LICENSE ❑21❑ PLA E# C90958V TAre 41 WA VIN# 1B7GL23X6VS256990 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ TRLR R 43 LR VIN#. N I #. VEH YEAR 1997 MAKE DODG MODEL DAKOTA STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI �44 L4❑ DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO OSVALDO ROMO MACIAS 4400 NE SUNSET BLVD 2A RENTON WA 98059 D:4255187796 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU&PORGY#E CO PROGRESSIVE 936707960IN 1GQ"'LE ❑ ,.I— CITATION# CHARGE LEGALLY YES N`LJ 25 =WARD AME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 11928 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED41732 COLLISION REPORT III III III III III 111 1591972 CASE# 23-2898 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) BEHM DEBORAH L (LAST FIRST, ADDRESS&PHONE# D O.B. ' 4400 NE SUNSET BLVD 12 RENTON WA 98059 2536535069 SEXi F MMDOYyvv 08 - 21 - 1961 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ ❑ 1 POS. 3 2 4 1 USE 2 CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) PETERSON QUINTIN L ADDRESS&PHONE# D O B 4400 NE SUNSET BLVD E2 RENTON WA 98059 2064745372 SEX M MMDovvvv 07 _ 10 _ 2006 PASSENGER [:]WITNESSZ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY POS. NATURE OF INJURIES 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' 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. S.WOODWARD 03-11-23 02:59 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 1 311212023 11:52:51 AM BADGE OR ID# 11528 OR]4f WA0171300 TIME POLICE DISPATCHED 1:10 PM TIME POLICE ARRIVED',1:17 PM PART I PAGE IT]OF❑ REPORT NO. ED41732 CASE# 23_2898 OCOLLOTINIE OFF CbLLI510N 03/11/2313:04 NARRATIVE All addresses listed herein, unless otherwise noted, are within the limits of the city of Renton King County WA. This report is a summation of events that occurred and is not an exact sequence of events. On 03-11-23, at approx. 1310 hrs, I was dispatched to 1400 Anacortes Ave NE to investigate a reported two vehicle blocking collision involving a red Dodge Dakota and a black Infiniti. These cars were later fully identified as follows: Veh 1 -Black 1997 Infiniti J30, WALP BIV5102, registered to Clifford Fairburn Veh 2 -Red 1997 Dodge Dakota, WALP C90958V, registered to Osvaldo Romo Macias. On arrival, I contacted Fairburn who confirmed he was the driver of Veh 1. He declined medical attention and gave me the following statement in summary: He was backing away from his apartment building, the I building, into the parking lot to leave the lot. He hit the gas by mistake and shot across the parking lot. He was able to avoid other cars but hit a fence and some rocks on the southeast corner of the parking lot, by the exit onto Anacortes Ave NE. He tried to brake but again hit the gas. His car went down the embankment and hit the red truck that was parked on the street. After the impact that spun the truck around, his car continued backwards, across Anacortes Ave NE, up over the east sidewalk and coming to a rest on the grass embankment on the other side of the road. I observed both vehicles, the damage to them and the position, finding these matched his account. I was contacted by the apartment complex manager, identified as Bekah Stewart, who said the fence and rocks belonged to the complex, identified as Sunset East. The unoccupied red truck belonged to a resident who was out of town currently. His wife arrived though and provided his information and the truck insurance to me. She and some friends were able to push the truck out of the road. Due to the damage to the Infiniti, it could not be moved, so I called a tow for it. Gene Meyers towing arrived and moved the vehicle out of the road. Later on, a witness returned and provided his statement, stating he had seen the collision. His statement matched the one given by Fairburn. I provided the exchange of information form to both parties in the collision. Photos taken and uploaded to evidence.com Nothing further. I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Sgt. S. Woodward #11528 3:04 PM 12/29/2022 Renton, King County, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED41 732 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-2898 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- �`"'j PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE u PEDESTRIAN � OWNER � YEs IN MIDDLE' 29 LAST NAME SUNSET EAST OPTS FIRST NAME , INITIAL STREET 30 NEW AnnRFrtP 4400 NE SUNSET BLVD CITY RENTON ST WA ZIP 98059 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES❑N0� YES N DRIVER'S STATE I SEX U M��DYSYv' —� 2 LICENSE 7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE cLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG E FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NEn+AnnREs.�' CITY'. ST ZIP CDL IGNITION REdUiREE7 IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. S.WOODWARD 03-11-23 02:59 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 F OR ID# 11528 O#I',WA0171300 APPROVED BY 3112/2023 PAGE�OF 3000-345-013(R 11118) REPORT NO. ED41732 CASE# ' 23-2898 DATE AND TIME 03/11/23 13:04 OF COLLISION N Anacortos Ave NE PAGE 5 OF 5