HomeMy WebLinkAbout23-9218 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-9218 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 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# ❑
COLLISION: 06 - 1-- 2023 1506 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
GARDEN AVE N BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e N 3RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2065366107 0 3 30
6� LAST NAME WASYE FIRSTNAME FATIMA MIDDLE I 1 1 2 31
INITIAL
STREET ❑, 17229 32ND AVE S APT E1 CITY SEATAC ST WA ZIP' 98188 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES z❑
USE CLASS TRANSPORTED TO HOSPITAL DUE TO
3
10 9❑ Pl QTNFS# CCL8352 STATE WA VIN If 5XYKWDA29BG160700
IT STATE TRAILER STATE
11 0 0 PLATE# I PLATE# I I FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE 5 3 34
13 1 2011 KIA SORENT UT DAMAGE vesNo � �MEYERS ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE NSURANCE CO PROGRESSIVE 918567726 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE36
LEGALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7576476157
a
LAST NAME WEDDINGTON FIRST NAME CLIFTON MIDDLE IR
INITIAL
17❑ STREET ❑' 1141 N 91 ST ST UNIT 302 CITY' SEATTLE ST WA ZIP 98103 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK vEs❑NOF YEs❑NO❑
19 LDIIVER # STATE WA SEX M M .C... 08 _ 28 _ 1985 El 39
—NATURE OF INJURIES
H USE CLASS
NJAURSY ADVISED WAS HAVING ACHES 40
20 F ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 2 7
21❑ LICENSE I BZE3480 TATe I WA VIN# JTDKN3DUXA0179898
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
By 44
G OV H I
VEH YEAR 2010 MAKE 7'Dy7' MODEL pRIUS STYLE $D DAMAGE TO TOWED
Yr
✓WED NOO BLIN GENE YES No
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DA GEbAREA
z Cdd
LIABILITY
INSURANCE &POLICY#E CO GEICO 6131696236IN 1 9TOP
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
7INAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26PH SINGER 12056 WA0171300
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88499
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9218
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STEWART MELANIE
(LAST FIRST,
ADDRESS&PHONE#
4258306130 SEX' IJ 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 B
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling east on N 3rd St crossing over Garden Ave N. The light at the intersection turned
red, and Unit 1 failed to stop at the light. Per the witness, Unit 1 drove through the clearly red light
and struck unit 2, who was making a right hand turn.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JOSEPH SINGER 08-11-23 03:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 811212023 9:32:50 AM
BADGE OR ID# 12056 OR]#' WA0171300 TIME POLICE DISPATCHED; 3:09 PM TIME POLICE ARRIVED 3:14 PM
PART I PAGE IT]OF❑
REPORT NO. ED88499 CASE# ' 23-9218 DATE AND TIME 08/11/23 15:06
OF COLLISION
One way
N 3rd'St
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