HomeMy WebLinkAbout23-4761 (2) ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-4761 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 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# ❑
cowsloN 04 - 1-- 2023 1820 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 160
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET MILES e S B W e I405 NB
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066120141 0 11
30
5� LAST NAME LYON FIRSTNAME NA THAN MIDDLE D 1 1 2 31
INITIAL
STREET ❑, 4229 NE 19TH ST CITY RENTON ST WA ZIP 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'M I D-MIDI Y' 02 - 17 - 2002 1 2 32
9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi ATNES# BYH0335 sTAr WAv N# 1 D4HB48N96F183539
---- TRAILER STATE PL TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 $ 34
13 3 2006 DODG DURAN SV DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA � 35
3 INSURANCE CO 4
14 LIABILITY INSURANCE ESURANCE INSURANCE CO PAWA-009377007
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLv Hla.e to BOTTOM 5 36
YES�No D CITATION# 3A0137177 CHARGE FAIL TO YIELD MOTOR VEHICLE 5
STANDING 8 7 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4254449659
16 a
LAST NAME WILLENBORG FIRST NAME DAVID MIDDLE G
INITIAL
17 STREET❑ NEW ADDREO 2517 BLAINE AVE NE CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDIIVEW # STATE WA SEX M M .C.B. 12 _ 11 1948 39
20❑ ON DUTY STATUS I
AIRBAG 3 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BHT3542 TArE 41
WA vIN# 1FADP3K28FL211375 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GoI
VEH YEAR 2015 MAKE FORD MODEL FOCUS STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 4872057CO847AIN STOP 5
'E""LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N`L J
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED56953
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4761
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'
On 04/27/2023 at 1825 hours I was dispatched to a motor vehicle collision at around the 100 blk on
Sunset Blvd NE at the on-ramp to 1405 NB. The driver of Vehicle 2 stated that he was proceeding
South on Sunset Blvd NE when he observed Vehicle 1 traveling North on Sunset Blvd NE and
attempting to turn left onto the i405 on-ramp. Driver 2 stated that Vehicle 1 failed to yield to oncoming
traffic and proceeded across the Southbound lane of travel on Sunset Blvd NE. Driver 2 stated that
he attempted to maneuver to the right of Vehicle 1 and was unable to stop. Driver 2 stated that he
made contact with the front passenger side of Vehicle 1 with the front of Vehicle 2. Driver 2 was
complaining of chest pain and was evaluated by Renton Fire Authority (RFA). Driver 1 stated that he
was traveling North on Sunset Blvd NE at around the 100 blk when he attempted to turn left to
proceed onto the i405 on-ramp. Driver 1 stated that he saw Vehicle 2 and did not have time to stop.
Driver 1 stated that Vehicle 2 collided with Vehicle 1 by making contact with Vehicle 1's front
passenger side with Vehicle 2's front. It should be noted that there is a yield sign at this intersection
for vehicles turning left from Sunset Blvd NE onto the i405 on-ramp. 1 advised Driver 1 that he would
be receiving a citation for failing to yield.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 04-27-23 08:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 1 5/4/2023 3:41:18 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 6:25 PM TIME POLICE ARRIVED 6:29 PM
PART I PAGE IT]OF 3�
REPORT NO. ED5 9 3 CASE# 2y4 8] A m°M\ 0 9»23 ]$2
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