HomeMy WebLinkAbout23-7098 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-7098 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 06 - 1-- 2023 1430 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK e✓ 500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BRONSONWAYNE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4256284002 0 11
30
6� LAST NAME SCHMIDT FIRSTNAME IAN MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 6422 E LK SAMM PKWY NE APT 11 CITy REDMOND ST WA ZIP 980526159 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� A6413781 sTArI WA vIN# 7FART6H91ME036408
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 3 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEARN MAKE HOND MODEL CR-VEX STYLE VEHICLE TOWED0NOOffBLIN T,OVWkkRS yOS❑ENO✓ 51
34
DAMAGE ILJI tSA1Wl6
13 REGISTERED OWNER INFO .1SCHMtDT.11ELKSAMMPKWYNEAPTII REDMONDWA980526159 D:4256284002 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 3
cL YES IN EFFECT &POLICY# 9TOP
VEwE CHARGE 36
LEc'LLv ❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2068162126
LAST NAME ROMAN FIRST NAME ADRIANA MIDDLE N
INITIAL
17❑ STREET ❑', 2120 JONES AVE NE CITY' RENTON ST WA ZIP 980562656 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DRIVER'S STATE I WA SEX F I D.O.B. 08 _ 01 1960 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BSS9853 TAre WA VIN# 1C4RJFBG3HC783486
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2017 MAKE JEEP MODEL GRAND STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ADRIANA ROMAN 2120 JONES AVE NE RENTON WA 98056 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU PORGY#E CO SAFECO INS H2258513IN �'E""LE
❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED76148
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7098
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LEE HONG E
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
6422 E LAKE SAMMAMISH PKWY NE 114 REDMOND WA 980526159 SEXi F MMDDvyvv 01 - 31 - 1986
PASSENGER I�I WITNESS�'UNIT# 1 PEA 3 AIRBAG 6 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE OF INJURIES
L�!1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) + $CHMIDT F
ADDRESS&PHONE#
REDMOND SEX' M MMDDvvvv 05 _ 05 _ 2022
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 4 AIRBAG 6 RESTR. 11 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 062223 1 responded to a 2-vehicle non-injury/blocking collision that occurred near the intersection
of Sunset Blvd NE and Bronson Way NE.
I contacted the driver of unit 2 who told me they were traveling northbound on Sunset Blvd NE
approaching Bronson Way NE when they were involved in a collision with unit 1. The driver did not
request medical attention but due to front airbag deployment of her vehicle, she was checked out by
Renton Fire. Unit 2 sustained front-end damage and required a tow.
I contacted the driver of unit 1, identified as Ian Schmidt (dob 10-13-1988) via his WA DL. Schmidt
said he was making left turn from Bronson Way NE to southbound Sunset Blvd NE and was involved
in a collision with unit 2. Schmidt said he misjudged the speed of unit 2 as she was approaching.
Renton Fire checked on Schmidt and his two passengers, including his infant son. Unit 1 sustained
heavy damage and required a tow.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Schmidt via SECTOR under RCW 46.61.180 -Failure to Yield.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 06-22-23 03:26 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 1 7/3/2023 3:12:36 PM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED! 2:30 PM TIME POLICE ARRIVED 2:35 PM
PART I PAGE IT]OF 3�
REPORT NO. ED76148 CASE# ' 23-7098 DATE AND TIME 06/22/23 14:30
OF COLLISION
BRONSON WAY NE
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