HomeMy WebLinkAbout24-1880 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 24-1s8o 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION 02 - 1-- 2024 2120 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RENTON ISSAQUAH RD S BLOCK NO. e✓ 14500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255259775 0 11
30
6� INITIAL
LAST NAME NAKANACAGI FIRSTNAME JONACANI MIDDLE V 1 1 2 31
STREET ❑ 11203 148TH AVE SE CITY RENTON ST WA 21p 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 09 1- 16 - 1989 2 32
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 . EJECT 1 H USE 2 CLASS 6 [NATURE OF INJURIES
CUT ON FORHEAD/KNEE z❑
3
10 9❑ P1 ATE 14 BRD3673 STATE WA VIN# KNAFU4A25A5182141
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 7 3 34
13 2010 KIA FORTE DAMAGE YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO JONACANINAKANACAGI 11203148THAVE SE RENTON WA 98059 D:4255259775 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE� INSURANCE CO NATIONAL GENERAL 2008123138
IN EFFECT &POLICY#
VEHICLe CHARGE BOTTOM ❑ 36
15❑ STANofNG YES No CITATION# 4AO084125 NEGLIGENT DRIVING 2ND DEGREE
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:2067861052
16 a
LAST NAME STAYNER FIRST NAME PETER MIDDLE A
INITIAL
17❑ NEW STREETR 12624 1
7 77TH PL SE CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19[—] DRIVER'S STATE WA SEX M D.O.B. 04 28 _ 1973 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# C95453T TATE 41
WA VIN1 1FTSX21536ED30821 1
42
22❑ PLATE# STATE pLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR 2006 MAKE FORD MODEL F250 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO PETER STAYNER 12624177THPL SE RENTON WA 98059 D:2067861052 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 942302277IN STOP 5
VEwcLE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N`LJ 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE53205
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1880
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
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'
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.
JAKE GALL 02-21-24 03:13 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 2/23/2024 6:34:37 PM
BADGE OR ID# 112617 OR]# WA0171300 TIME POLICE DISPATCHED', 9:22 Pry TIME POLICE ARRIVED]9:26 PM
PART I PAGE IT]OF 4�
REPORT NO. EE53205 CASE# 24-1880 OF COLLISION
02/20/24 21:20
OF CbLLI510N
NARRATIVE
*This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized. *
The following occurred within the City of Renton, WA and was recorded on my body worn camera.
Vehicle 1 was traveling West on Renton Issaquah RD SE near the 14500 block. Vehicle 2 was
traveling East. The road slightly curves into a "U" shape at the impact location. Vehicle 1 appeared to
have crossed over into oncoming traffic and impacted vehicle 2 head on causing significant damage.
Driver 1 had left the scene before Police/Fire arrived in an unknown direction. Driver 2 had no
apparent injuries and was wearing his seatbelt at the time of impact. Driver 2 was evaluated by Fire
but declined to go to the hospital at this time.
Driver 2 was able to provide all the necessary documents. I provided him with my business card and
case number. Driver 2 stated that he was traveling East at the above listed location. He observed
vehicle 1 traveling West and cross over into his lane, causing a head on collision. Driver 2 never saw
or was able to identify Driver 1.
Both vehicles were totaled and towed by Banker's towing.
A few hours after the incident, Driver 1's father had called in saying his son was involved in a collision
and ran from the location home. The father advised that his son was HBD at the time he returned
home.
I contacted Driver 1 at his father's residence which was near by the accident location. Driver 1 had a
large cut on his forehead and knee which would need stiches. Driver 1 apologies for not staying at the
scene and understood it was a crime. Driver 1 provided his insurance and registration info.
Driver 1 stated that he was very fatigued and tired, which caused him to cross over into oncoming
traffic and cause the collision. I advised him that too much time had passed at this point to process
him for DUI and his father's observations of him being HBD did not give me probable cause.
I provided driver 2 with driver 1's insurance information. Driver 2 is unsure if he wants to be a victim of
Hit and Run at this time.
I completed infraction 4AO084125 for Negligent driving 2Nd degree. Driver 1 operated a motor vehicle
in a manner that is both negligent and endangered Driver 2 and himself by being "fatigued and tired",
causing a head on collision.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by J. Gall/12617
02/21/24 at 0300 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. EE53205 CASE# 24-1880 DATE AND TIME 02/20/24 21:20
OF COLLISION
s ..
1
m u�•'�+aa�.J +.lusty.
i
3�
s
PAGE 4 OF 4