HomeMy WebLinkAbout24-3458 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-3458 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 1 �2$
TRIBAL UNITS 01 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 03 - 1-- 2024 1655 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N SOUTHPORT DR BLOCK NO. e✓ 1200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 2❑ 200 00 FMILES
EET e S ❑ E e LK WASHINGTON BLVD N
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 30
6� LAST NAME WORK FIRSTNAME JASON MIDDLE 1 1 2 31
INITIAL
STREET ❑ 2105 NE 23RD SL CITY RENTON ST WA ZIP 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NOZINTERLOCKYEs NO�/ YES �/ NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 13 EJECT 1 HELMET 5 INJURY 6 NATURE OF INJURIES z❑
USE CLASS PAIN IN LEFT SHOULDER AND ARM
3
10 Pl ATNFS# OF3159 STATE WA VIN#' WB10317A272R42467
C7
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12❑ VIN# VIN#
FROM
34
13❑ VEH.YEAR 2007 MAKE BMMC MODEL TWO STYLE MC VEHICLE TOWED NE pLSABLIN TSIYYEp9vMEYERS vOs❑ENo�
HICLE
DAMAGE IILLJJII (��IV6
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑ SHADE IN DAMAGED AREA ❑ 35
14 LIABILI V INSURANCE INSURANCE CO UNKNOWN 3 4
IN EFFECT &POLICY#
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING
UNIT a2 VE IMOTOCLE ❑ CYCLE ❑ PEDESTRIAN ❑ oWNFR PEDAL RTY ❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 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❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BV 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 VE."Le ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N J
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
N/COLAS SANGDER 7 11350 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE77512
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3458
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ROBERTSON HEATHER
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B.
4319 LAKE WASHINGTON BLVD N KIRKLAND WA 98033 4255918015 SEXi F MMDDYyry 11 - 09 - 1970
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. ' USE CLASS
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# Id DOB
E MMDDYVYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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'
Within the City Limits of Renton, King County, Washington, while working uniformed patrol for the
City of Renton in a marked police vehicle the following occurred.
On 03/30/24 at approximately 1702 hours I was dispatched to an injury collision which occurred in the
1200 block of N Southport Dr.
While driving to the location dispatch relayed the collision involved one motorcycle, with the injured
party being the rider, who was conscience with possible arm and face injuries.
I arrived on scene at approximately 1706 hours and noticed the driver of Unit 1, identified by WADOL
photo as Work, Jason D. (11/19/74), sitting on the south side of N Southport Dr. He was able to talk to
me and complained of pain in his left shoulder and left arm. Work told me he was driving westbound
in lane two on N Southport Dr when a vehicle came over into his lane cutting him off. Work hit his
brakes to avoid the vehicle, wherein he lost the front wheel and laid the bike down. The damage on
Unit 1 is consistent with Work's story.
A witness to the collision, identified as Robertson, Heather was driving in lane three of N Southport Dr
when she heard a scraping sound from the left of her vehicle. She stated she saw the bike slide past
her vehicle before coming to rest. Robertson did not notice the vehicle that cut off Work and there
were no other witnesses to the incident.
Work was treated by Renton Fire at the scene before being transported to Valley Medical for his
injuries. Unit 1 was impounded from the scene by Gene Meyer.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NICOLAS SANGDER 03-30-24 07:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 1 511612024 2:14:34 PM
BADGE OR ID# 11350 ORI# WA0171300 TIME POLICE DISPATCHED! 5:02 PM TIME POLICE ARRIVED;5:06 PM
PART I PAGE IT]OF 3�
REPORT NO. EE77512 CASE# ' 24-3458 DATE AND TIME 03/30/24 16:55
OF COLLISION
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