HomeMy WebLinkAbout23-5011 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-5011 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 01 STRUCK' MSC OBJECT OR DEBRIS ON ROAD
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 05 - 03 - 2023 1839 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 164TH ST BLOCK NO. e✓ 13025
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
6❑ 200 00 FEET MILES e S ❑ W e 131 AVE SE
❑29
MOTU '�01 VEHtOC E ElCYOCLE. �ESAGE NHORE✓LD MET PHONE 30
6 LAST NAME OLSON FIRSTNAME JON MIDDLE K 1 31
INITIAL
STREET ❑ 16405 126TH AVE SE CITY RENTON ST INA ZIP 98058 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ L RIENSE#VERS STATE SEX'M MMDDBI Y 32
9 ON DUTY❑ STATUS' 1 AIRBAG RESTR EJECT 3 HELMET U E 2 CLASSY 5 [NATURE OF INJU
HEAD TRAMARIES z❑
3
LICENSE STATE uN#'
10❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ VIN# UIN#
FROM
34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
2 DAMAGE YES NO YES[:] NO
13 O
REGISTERED OWNER INFO VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vEcnLLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 10 BOTTOM
15 LE❑ STAIN,'" 8 6
UNIT U2 MOTORVEHIC
❑ CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES H OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIRIVERSTICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
21 2❑ LICENSE I TATE YIN# 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 I 9TOP 5
VE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES❑ Nu
25 4 4 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
N AAH G/RELLO 12607 0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED57048
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5011
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ROUSU ERIN
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
13070 SE 161 ST ST RENTON WA 98058 2069205565 SEXi F MMDovyry 08 - 14 - 1978
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) ROUSU KEITH C
ADDRESS&PHONE# D O B
13070 SE 161ST ST RENTON WA 98058 2069791029 SEX I M MMoovvvv 09 _ 22 _ 1975
PASSENGER []WITNESS POS. USE CLASS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
NAME
(LAST FIRST,MIDDLE INITIAL) SIMMS RYAN
AooREss&PHONE# 13105 SE 164TH ST RENTON WA 98058 4255907786 SEX M D•O•B• O6 M _ 13 _ 1999
MDDYYYY
PASSENGER WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET INJURY 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.
NOAH GIRELLO 05-03-23 09:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 1128E 1 5/4/2023 9:54:25 AM
BADGE OR ID# 112607 ORI# WA0171300 TIME POLICE DISPATCHED 6:40 PM TIME POLICE ARRIVED',6:45 PM
PART I PAGE IT]OF 4]
REPORT NO. ED57048 CASE# 23-5011 OF COLLISION
05/03/23 18:39
OF CbLLI510N
NARRATIVE
23-05011
At about 1840 hours on 05/03/2023 1 was dispatched to an accident with injuries at, 13025 SE 164TH
ST, in the city of Renton, King County, Washington. Dispatch advised me that motorbike rider went
down in the roadway and was unresponsive and bleeding from his face.
Upon my arrival I got out and assisted as other officers and medics started to render aid. The medics
then took over rendering aid to the subject. The subject was later identified as Jon K Olson (DOB
12/30/1954) via WADOL. Olson was the only involved unit in this accident. Olson was the sole
occupant on an electrically powered bicycle. Upon my initial observation it did not appear that Olson
struck any other objects with his bicycle. The accident occurred in front of the above address, just
west of the intersection of SE 164TH ST and 131 ST AVE SE.
At the scene Olson had a pulse and was conscious but in serious condition. Olson had sever
lacerations to his face and head and was bleeding profusely. After the medics loaded him into the
ambulance for transportation, I started to contact witnesses.
The first witness was identified as Erin Rousu (DOB 08/14/1978). The following is a summary of what
Erin told me. Erin explained that she was traveling west bound on SE 164th ST while Olson was
traveling the opposite direction going east on SE 164TH ST. Erin stated that as Olson approached
their vehicle, he took one hand off his bicycle and lost control of his bicycle and stated to fall. Olson's
speed was estimated at about 20-25 MPH. Erin said she did not see Olson strike any other objects.
Erin stopped and rendered aid to Olson until our arrival. Erin later provided me with a written
statement.
No other motor vehicles were involved in this accident, and I was unable to obtain a serial number
from the bicycle at the scene. Olson was transported to the hospital to be treated for his injuries.
Pictures of the scene were taken and uploaded via AXON capture.
This concludes my involvement with this case. Please see other officers' supplemental reports for
further information.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by N. GIRELLO #12607 on 05/03/2023 at 0300 Renton, WA
PAGE 3 OF 4
REPORT NO. ED57048 CASE# ' 23-5011 DATE AND TIME 05/03/23 18:39
OF COLLISION
II
SE 154th ST
IJJ
co
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PAGE 4 OF 4