HomeMy WebLinkAbout24-6164 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-6164 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1❑ OF 1 3 628
TOTAL#
TRIBAL UNITS 02 OBJECT CONCRETE/JER
STRUCK SEYBARRIER
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. Os — 11 — 2024 2245 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ VV e SW GRADYWAY
0 1 29
MOTU '�01 VEHtOCLEZ PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST 21P z
NEW ADDRESS
7❑ ODL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
DRIVERS
STATE SEX D '❑- 328 LICENSE MMDYY❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
1 Q❑ PI ATE 14
TRAILER q STATE 0 TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
rRLR. TRLR. m
33
12❑ VIN#' VIN#
VEH.YEAR MAKE MODEL STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 34
13❑ DAMAGE YES NO ✓ VES❑ NO✓
REGISTERED OWNER INFO UNKNOWN RENTON WA 98057 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
5
VEwcLE 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STAND
ING 8 6
UNIT 02 MOTO
R ❑ CYCLE ❑ PEDESTRIAN ❑✓ OWNER
❑ DYES✓ NO OLD MET PHONE
VEHIC16 a
LAST NAME ROHN FIRST NAME ANTHONY MIDDLE I L
INITIAL
17❑ STREET ADOREss❑' 9601 STEILACOOM BLVD SW CITY LAKEWOOD ST WA ZIP 98498 37
❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICALt-T�RANSPORTED � 38
INTERLOCK YES�NO� INTERLOCK YEs It I No� YES t l NO❑
19[—] DRIVER'S STATE WA SEX M I D.O.B. 12 _ 19 _ 1992 39
LICENSE# MMDDYY
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT I H U SE
2 LASSY 6 MINOR CUT ON THE FORHEAD ❑ 40
❑21❑ TATE 41
IN#LICENSE V `1
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE PLATE#ILER STATE
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 1 9 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE"LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=TAMAIVENA
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12812 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE92586
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6164
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MCCLA►N N►CHOLAS
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
HOMELESS RENTON WA 98056 SEX M MMDDYyry 12 - 03 - 1991
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
�✓ POS. i USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Id I DOB
E MMDDYVYV
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'
The witness stated that he saw the driver of a black pickup truck traveling southbound on Rainier Ave
S, cross street SW Grady Way. The black pickup truck was in lane 3 when he got a green light. The
pickup truck then started to drive forward. The pedestrian was in the middle of the median and started
walking across the street when the cars traveling southbound had a green light. the pedestrian
disregarded the traffic and continued to walk across the street. The witness heard someone yell
watch out for the trailer. The pedestrian then got struck by the trailer that belonged to the black pickup
truck. The black pickup truck continued traveling southbound onto Highway 167.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Location Character: IN THE MEDIAN
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
S/TIVENI TAMAIVENA 06-12-24 01:20 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 7/3/2024 11:54:12 PM
BADGE OR ID# 1Y812 OR]# WA0171300 TIME POLICE DISPATCHED 10:46 PM TIME POLICE ARRIVED',10:47 PM
PART I PAGE IT]OF 3�
REPORT NO. EE92586 CASE# 24-6164 DATE AND TIME 06/11/24 22:45
OF COLLISION
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