HomeMy WebLinkAbout23-3866 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-3866 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
1 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 04 - 04 - 2023 1951 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE CARR RD BLOCK NO. e✓ 10400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S ❑ W e 105TH PL SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2066733773 0 9 30
6� LAST NAME SAECHAO FIRSTNAME DEON MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 4310 NE 5TH ST,APT A204 CITY RENTON ST WA 2jp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CGH0815 sTArI WAurN# 1 FAFP40462F176685
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE 9 9 34
13 4 2002 FORD MUSTAN CP DAMAGE vesNo � �MEYER YES❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO <53 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
E�ALLv YEs❑NO CITATION# 3A0251782 OP MOT VEH W/OUT INSURANCEorrom
15❑ STANDING 7 6
MOTOR Z PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:2062492920
16 a
LAST NAME HABTEMARIYAM FIRST NAME DINKU MIDDLE T
INITIAL
17 STREET I❑ s❑' 3604 S 180TH ST,APT B11 CITY' SEATAC ST WA ZIP 98188 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDIIVER # STATE WA SEX M M .C.B. 05 _ 20 _ 1991 39
F—NATURE OF INJURIES
20� ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U NE ET LAU Sy 7 COMPLAINT OF BACK PAIN ❑ 40
❑ILICENSE 21❑ PLA E# BXH1843 TArE 41
WA VIN# JHMZE2H71AS008831 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BV Gov HI 44
VEH YEAR 2010 MAKE HOND MODEL INSIGHT STYLE 4D DAMAGE TO WED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO STATE FARM 534 6934-CO3-47IN 1 STOP
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES N�
25❑ s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JASON JONES 11635 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED48554
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3866
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 4-4-23, at about 2000 hours, I was dispatched to a collision that occurred in the 10400 block of SE
Carr RD.
Upon I arrival, I saw a white sedan (Unit 2) pulled into a parking lot and appeared to have damage to
the rear of the vehicle. I also observed a silver coupe (Unit 1) still in the roadway and it appeared to
have major front-end damage and required a tow.
I contacted the driver of Unit 2 and he stated his back hurt and refused an evaluation by Renton Fire.
He relayed the following: he stopped (no traffic was in front of him) and planned to make an illegal
left hand turn in the 10400 block. The driver told me when he stopped, he was stuck by Unit 1.
The driver of Unit 1 confirmed the above account of the incident. He was contacted by Renton Fire
and also declined to be evaluated.
The driver of Unit 1 did not have insurance and was given a citation. He was also given a verbal
warning for inattention.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON JONES O4-04-23 08:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 4/4/2023 10:11:49 PM
BADGE OR ID# 11635 ORI# WA0171300 TIME POLICE DISPATCHED; 7:54 PM TIME POLICE ARRIVED';8:02 Pry]
PART I PAGE IT]OF
REPORT NO. ED48554 CASE# ' 23-3866 DATE AND TIME 04/04/23 19:51
OF COLLISION
Aorlwal ol
Mir
NOT TO SCALE
e
SC CARR RD
i
t�
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