HomeMy WebLinkAbout23-5555 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-5555 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT ❑2$
TRIBAL UNITS 01 STRUCK' FIRE HYDRANT
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GawsloN 05 - 17 - 2023 0626 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
UNION AVE NE BLOCK NO. e✓ 800 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e NE 8TH ST
0 1 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElDESA✓NHORESHOLDMET PHONE 30
6� LAST NAME UNK 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 INTERLOCK YES NO YES No
DRIVERS
STATE SEX D '❑- 328 LICENSE MMDYY❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 9 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10❑ Pi ATNES# AQC2673 sTATe WAv N# 2yKRL1864XH006202
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. A'RLR. 1 5 33
12❑ vIN#' VIN#
Rom 34
13� VEH.YEAR 1999 MAKE yOND MODEL ODYSSE STYLE VN VEHICLE TOWED NOO pLSABLIN TSIYYEp9vMEYERS vOVT.V
DAMAGE IILLJJII (��IV6
REGISTERED OWNER INFO UNK VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILIT INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# OPICL CHARGE 36
LEGALLvYes❑NO CITATION# <11,
TTOM15❑ STAINDIING6
UNIT 02 MOTO
R ❑ CYCLE ❑ PEDESTRIAN ❑ PROPERTY ❑ D YES NO OLDMET PHONE
16 VEHIC❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY Sr Zlp ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRES
ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES I I NOF YES t l NO❑
19 LLIICENS RIVEWS# STATE SEX MMDDYY —❑_ 39
-----WELMET NATURE OF INJURIES 4O
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TATE VIN# 41
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE pLATE#ILER STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JAC08S 1953 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED67205
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5555
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JOHNSON KELLI
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2063516658 SEX' F MMDDYYYY -❑
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O 8
SEX' MMDDVVYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 5-17-23 at about 0635 1 arrived in the area of 800 Unon Ave NE for a single vehicle collision into a
light pole and a fire hydrant. The vehice, WA plate AQC2673 was unoccupied. An area check for the
driver or victims of the collision was negative. 1 requested that dispatch have the agency in the
jurisdiction of the registered owner go out to see it the vehicle was an unreported stolen vehicle.
Dispatch later returned the vehicle was not stolen. Investigation showed;
Unit 1 was southbound when, for unknown reasons, unit 1 crossed over northbound lanes and drove
onot the east side sidewalk. Unit 1 then struck the light pole and hydrant before coming to rest. The
driver fled on foot and could not be located. The vehicle was impounded due to blocking the roadway
and being abandoned.
This collision occurred in the city of Renton, County of King.
I declare uner peanity of perjury that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 05-22-23 11:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/5/2023 2:28:13 PM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 6:26 AM TIME POLICE ARRIVED',6:30 AM
PART I PAGE IT]OF 3�
REPORT NO. ED67205 CASE# 23-5555 DATE AND TIME 05/17/23 06:26
OF COLLISION
Aw
tq
;, y� averr r�� ,,maaWtid,d
4
t,
1
S.r �
t t
F
PAGE 3 OF 3