HomeMy WebLinkAbout23-4573 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-4573 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
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 04 - 1-- 2023 1623 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e LAKEAVES
0 1 29
UNIT 01 MOTOR CYCLE
❑ YES ]NO
MET PHONE 0 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY TACOMA ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY — 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 9 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#
10[ PI ATE#
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 2 5 vIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 1 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY#VE—L' CHARGE36
LECALLv YES❑NO CITATION# U�,
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2532498816
16 a
LAST NAME PENCE FIRST NAME ALEXANDER MIDDLE R
INITIAL
17❑ STREET ADDRESS❑' 447 PAR K A VE N CITY RENTON ST WA ZIP 98057 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YES It1 I NoF t l YES NO
19 F] D IVE
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# AMA0583 TATE WA vIN# 1(B1AK55F467725473 1
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2006 MAKE CHEV MODEL COBALT STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV!TN
44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ROBERT PENCE 1721325TH AVENUE CT E TACOMA WA 98445 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY INSURANCE INSU8 PORGY#E CO LIBERTY MUTUAL A0226885008540 2 8 1GQ,
IN EFFECTVEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N`E]
25 s � e
7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# [AGENCY
26
MIN FLICK 12825 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED56464
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4573
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.
BENJAMIN FLICK 04-23-23 07:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 5/2/2023 8:58:27 AM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED 4:32 Pry/ TIME POLICE ARRIVED',5:08 PM
PART I PAGE IT]OF 4�
REPORT NO. ED56464 CASE# 23-4573 OF COLLISION
04/23/23 16:23
OF CbLLI510N
NARRATIVE
23-4573
On 4-23-2023 at approximately 1634 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a hit and run motor vehicle
collision in the 200 block of S 2nd ST. The reporting party was standing by at the Taco Time.
Upon arrival I made contact with reporting party Alexander Robert Michael Pence (DOB: 02-09-2002
via WADOL). He explained to me the following circumstances:
Unit 01 (unknown plate) was a hit and run driver with no suspect information other than a red SUV
driven by an unknown race male.
Unit 02 (WA/AMA0583), driven by driver Pence, was driving westbound in the farthest south lane on
S 2nd ST when the driver in unit 01 "side swiped" his vehicle while driving in the same direction. Unit
01 left their own lane and their driver side collided with the passenger side of unit 02, leaving dents
and a paint transfer.
Unit 02 then left the collision scene northbound on Lake Ave S without stopping.
I provided Pence with a Sector printout which contained the case number.
I observed that the damage to the vehicle was consistent with what Pence had told me, including red
paint transfer.
At the conclusion of my investigation, I determined that driver Pence had been struck by a vehicle
and that the suspect driver had fled the scene. There is no significant suspect information useful for
follow-up. This report was written for information only.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 04-23-2023 in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED56464 CASE# ' 23-4573 DATE AND TIME 04/23/23 16:23
OF COLLISION
nit 01
II
Not to Scale
IIIVIV
200 block S 2nd St Unit 02
PAGE 4 OF 4