HomeMy WebLinkAbout23-4829 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-4829 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 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# ❑
cowsloN 04 - 1-- 2023 1545 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 7TH ST BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2067513447 0 11
30
6� LAST NAME MESHESHA FIRSTNAME WEGENIE MIDDLE W 1 1 2 31
INITIAL
STREET ❑, 17223 32ND AVE S APT A30 CITY SEATAC ST WA ZIP' 981884415 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVERS STATE WA SEXI M MI DAY' 05 1— 31 — 1977 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 9❑ P1 ATE 14 CFX2523 STATE WA u N# 5TDKRKEC4MS015634
TRAILER STATE TRAILEC$ STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 2 2021 TOYT SIENNA VN DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO PVHOLDING CORD 15820INTERNATIONAL BLVD TUKWILA WA 98188 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SELF INSURED PV HOLDING CORP 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES No CITATION# 3A0357728 FAIL YIELD LEFT TURN MOTOR o eorrom
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252716316
16 a
LAST NAME HA YES FIRST NAME CHERYLE MIDDLE K
INITIAL
17❑ STREET ❑', 12646 SE 165TH ST CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NoF,/
19 LICENSE# STATE WA SEX F M .C.B. 05 _ 25 _ 1955 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE BOL8566 TATe 41
WA vIN# 4T1BG22K3VU121762
❑
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 1997 MAKE TOYT MODEL CAM4D STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO CHERYLE HAYES PO BOX 58444 RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 900524969IN 1 VEHICLe [:] CITATION# CHARGE
25 UQ,
LEGALLY YES N
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED56493
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4829
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HAYES ROBERT
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
12646 SE 165TH ST RENTON WA 980585546 2064841637 SEX M MMDDYyry 03 - 16 - 1949
PASSENGER I�I WITNESS UNIT# 2 POS 13 AIRBAG 2 RESTR. 4 EJECT ? 1 H U SE 2 CLASS 1 NATURE of INJURIES
NAME L�1
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYVYY
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'
Unit 2 was traveling eastbound in the 100 blk of SW 7th ST in the right lane approaching traffic
backed up from Hardie AVE SW. Unit 1 was in the center turn lane facing west in the 100 blk of SW
7th ST intending to turn left into the parking lot of Walmart/Jimmie Mac's. The traffic backed up was
mostly in the left lane of E/B SW 7th ST and some drivers had made space for other vehicles
intending to make the same turn as Unit 1. Unit 1 failed to assure the far south, eastbound lane of
travel (the lane Unit 2 was approaching in with the right of way) was clear and initiated the turn. Unit
1 pulled into the path of Unit 2 and the front end of Unit 1 struck the front drivers corner of Unit 2.
Both units sustained moderate damage but Unit was disabled due to damage to the wheel. Unit 2
was towed by Bankers tow.
Driver 1 cited for failure to yield to a motor vehicle when making a left turn by making the left turn into
the path of Unit 2 which had the right of way which was the proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 05-01-23 08:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 5/2/2023 12:46:25 PM
BADGE OR ID# 10008 ORI 4$ WA0171300 TIME POLICE DISPATCHED 3:48 PM TIME POLICE ARRIVED]3:57 PM
PART I PAGE IT]OF
REPORT NO. ED56493 CASE# ' 23-4829 DATE AND TIME 04/29/23 15:45
OF COLLISION
f
l
Parking Lot a
Jimmy Mac's 1WImart
` ***NOT TO SCALE***
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