HomeMy WebLinkAbout23-3317 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
CASE 23-3317 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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# ❑
cawsloN 03 - 1-- 2023 2226 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e✓ 15800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 1. 00 FEET MILES e S B W e S 168TH ST
1 5 29
UNIT 01 VEHICLE
MOTZ PEDAL-ORCYCLE ElDESA✓NHORESHOLDMET PHONE 1 4 30
6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YEs No✓
8 DRIVERS. STATE SEX.U D.Q.B. 1 32
❑ :LICENSE# MMDDYY —=
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10� PI ATE
S14 E I NO PLATE sTAT1 VrN#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 0 33
12 0 0 vIN# VIN#'
FROM
� ❑
❑ VEH.YEAR MAKE DODG MODEL RAM STYLE TR VEHICLE TOWED TO BLIN 34
TOWED BY GOVT.VEHICLE
13 9 DAMAGE YES NO ✓ YES NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑
INSURANCE CO 2
IN EFFECT &POLICY# 9TOP
vewcLE CHARGE 1 1060TTOM 5 36
LEGALLv res❑NO❑ CITATION# 5
15❑ STAIN,D" 8 7 6
UNIT U2 MOTOVEHIR
CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET
CITY' Sr ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED � 38
INTERLOCK YES❑No� INTERLOCK YES It1 I NoF t l YES NO
19 LLIICENS RIVEWS# 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 ❑
❑21❑ PLATE# 69578D TATe 41
WA vIN# 1GNLCDEC5LR247357 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2020 MAKE CHEV MODEL TAHOE STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO CITY OF RENTON 1055 S GRADY WAY RENTON WA 98057 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#ECO CITY OF RENTON FLEET COVERAGEIN 1 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
G.BARFIELD 6475 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED44741
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3317
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'
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.
G.BARFIELD 03-23-23 12:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
P.SUMMERS 8887 312312023 1:05:09 AM
BADGE OR ID# ! 6476 OR]# WA0171300 TIME POLICE DISPATCHED 10:26 PM TIME POLICE ARRIVED 10:29 PM
PART I PAGE IT]OF 4�
REPORT NO. ED44741 CASE# 23-3317 OF COLLISION
03/22/23 22:26
OF CbLLI510N
NARRATIVE
On 3/22/23 at approximately 2219 hrs, Officer Sims, along with other officers, responded to a call of
unwanted subjects at 16807 108th Ave SE in the city of Renton, King County, Washington. Dispatch
had advised that there were unwanted and previously evicted subjects on the property.
Officer Sims arrived with Officers Girello and Smith. There was a white older Dodge Ram 2500 in the
driveway to the residence. Officers approached the vehicle which was occupied by a white male
driver. As officers approached, the driver threw the vehicle into reverse and backed up to flee.
Officers Sims vehicle was parked behind and to the passenger side of the Dodge Ram, approximately
15 behind it. As the suspect driver backed up at a high rate of speed, it drove down the driver's side
of Officer Sims patrol vehicle without coming into contact with it.
As the suspect vehicle cut its wheels to turn around and flee, the passenger side rear of the suspect
vehicle struck the driver's side rear of Officer Sims' patrol vehicle, damaging the driver's side rear
quarter panel and bumper. The vehicle exited onto 108th Ave SE and fled the scene. No one was in
Officer Sims' vehicle at the time of the collision and there were no injuries reported. The identity of
the suspect driver is unknown.
The driver was described as a white male, red hair, blue eyes and wearing a black jacket and black
hat.
I responded to the scene to conduct the traffic investigation and photographed Officer Sims' vehicle.
The vehicle was drivable and was driven to the city shops and put out of service for repairs.
There is no further information at this time.
PAGE 3 OF 4
REPORT NO. EU44741 CASE# 23-3317 DATE AND TIME 03/22/2322:28