HomeMy WebLinkAbout23-10957 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-10957 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 ❑28
TRIBAL UNITS 02 STRUCK STREET LIGHT POLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 09 - 1-- 2023 2348 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 3RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e JEFFERSON AVE NE
2 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2065027143 30
6❑ LAST NAME MERON FIRSTNAME JAPHETH MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 11901 85TH AVE S CITY SEATTLE ST WA 2jp, 981784032 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 12 — 03 — 2006 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ pl ATE 4 919XXQ sTAT WAv N# 2HKYF184X5H506315
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ VIN#j VIN#
FROM
34
13� VEH.YEARN MAKE HOND MODEL PILOT STYLE UT VEHICLE TOWED0NOOffBLIN TSIgWgYMEYERTOW v�s❑ENo�
DAMAGE IILLJJII (5�IV6
REGISTERED OWNER INFO MERON BERAKl 1110185TH AVE S SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE INSURANCE CO SAFECO 142546298 3
IN EFFECT &POLICY# 9TOP
VEI-1 CHARGE 36
LEGA YES❑NO CITATION# 3A0665529 SPEED TOO FAST FOR CONDITIONS o aorroM
15❑ STANDING 8 7
MET MOTOR PEDAL-:. ',PEDESTRIAN PROPERTY DAM THR OLD PHONE
UNIT a2 VEHICLE El
❑ ❑ OWNER ❑ YES 1/ NO D:4254307500
16❑
LAST NAME CITY OF FIRST NAME RENTON MIDDLE
INITIAL
17❑ NEW STREETR 1055 S 7 GRADY WAY CITY RENTON ST WA ZIP 98057 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK vEs It I NOF YES
t l NO❑
19 LLIICENS # STATE SEX rJ MMDDYY —❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN It IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 970E 5
NODALOVIC
❑ C[:] CITATION# CHARGE i o BOTTOM
YES N
25 s e
'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
11628 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE01988
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10957
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SARA SHELHORSE
(LAST FIRST,
ADDRESS&PHONE#
2058756311 SEX' U MMDDYYYY -❑
---------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# SEXI D O B
MMDDYVYY
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'
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.
N.ODALOV/C 09-24-23 04:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 9/25/2023 4:09:15 AM
BADGE OR ID# 11628 OR]#' WA0171300 TIME POLICE DISPATCHED; 11:48 PM TIME POLICE ARRIVED 11:48 PM
PART I PAGE IT]OF 4�
REPORT NO. EE01988 CASE# 23-10957 OF COLLISION
09/23/23 23:48
OF CbLLI510N
NARRATIVE
23-10957
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 09-23-2023 at approximately 2348 hours I was dispatched to Jefferson Ave NE / NE 3rd St for a
single vehicle collision.
I arrived on scene at approximately 2357 hours. Upon my arrival, observed WA Lic/919XXQ parked
on landscaping near Arco AMPM, 2900 NE 3rd St with significant damage to the rear trunk area. The
solo occupant and driver was identified as Japheth S. Meron (DOB 12-03-2006). Meron stated he
was not injured. Meron stated he lost control of his vehicle as he was traveling westbound on NE 3rd
St passing Jefferson Ave NE. Meron stated he closed his eyes and wasn't exactly sure what
happened once the vehicle started to spin. Meron's friends were traveling in a separate vehicle near
Meron and witnessed the collision. One of the friends was verbally identified as Sara Shelhorse. Sara
stated Meron's vehicle lost control and the vehicle spun around backwards making impact with the
light pole before coming to rest in the landscape area in front of Arco AMPM.
Vehicle marks on the roadway, debris and damage indicated the vehicle was facing eastbound when
impact with the light pole was made. The listed pole number is #2101 D.
The vehicle was privately impounded by Gene Meyer Towing.
I took photos of the scene, and the photos were later uploaded to evidence.com.
Meron was cited for RCW 46.61.400 speed too fast for conditions via mail.
I stayed on location for traffic control until the scene was cleared.
During this incident I was equipped with body-worn camera which records both audio and video.
Portions of the incident were recorded. This report is merely a summary of the incident and is not
intended to be an exact transcription of the entire investigation or what may have been captured with
the recording system.
PAGE 3 OF 4
REPORT NO.! EE01988 CASE# 23-10957 DATE AND TIME 09/23/23 23:48
OF COLLISION
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