HomeMy WebLinkAbout23-7111 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-7111 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENC 4100 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#
cawsloN 06 - 1-- 2023 2308 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON DR S BLOCK NO. e✓ 2100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e S 21ST STREET
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2064603788 0 11
30
6� LAST NAME ANGLE FIRSTNAME MATTHEW MIDDLE R 1 2 31
INITIAL
STREET ❑, 2130 SHATTUCK AVE SOUTH CITY RENTON ST WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YEs No�/
8❑ LRIIVER # STATE WA SEX'M MMDD 12 — 30 — 2002 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ PI ATFBit CAR8873 sTArI WA vrN#' JT2BF28K6X0194173
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR $ 7 33
vIN#
12 3 5 ' YIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 1 $ 34
13 4 1999 TOYT CAMRY DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO MATTHEWANGLE 2130 SHATTUCKAVE SOUTH RENTON WA 98055 D:2064603788 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO USAA 0484439017101 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2066683900
16 a
LAST NAME MORRISON-HIBBARD FIRST NAME TRENTON MIDDLE S
INITIAL
17 STREET❑ NEW ADDRESS❑' 10930 SE 172ND ST APT N101 CITY RENTON ST WA ZIP 98055 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 D STATEWSEXM .CB. _ 0 39
# M .
WELMET INJURY6 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 USE CLASS NECK AND LOWER BACK
LICENSE I ❑21❑ PLA E# CFA5771 TAre 41
WA vIN# 1N4AA6AP3GC400536 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2016 MAKE NISS MODEL MAXIMA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO GENE MEYERS YES NO
REGISTERED OWNER INFO TRENTON MORRISON-HIBBARD 10930 SE 172ND ST APT N101 RENTONWA98055 D:2066683900 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 5217812-1310-47IN 9TOP 5
VL LE GAEGA LYLLY Y ❑ ,.I—_
CITATION# CHARGE to BOTTOM
ES N`[
25 ' e
7DADAM
S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
1254 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73326
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7111
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'
Narrative:
The following incident occurred in the City of Renton, in the County of King in the State of
Washington.
The incident was captured on by body worn camera. The report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 6-22-23 at approximately 2313hrs, I responded to S 21 st Street and Benson Drive South
on a report of a possible injury collision.
Upon arrival I observed 2 vehicles with front end damage. Vehicle 2 had been traveling
southbound on Benson Drive and stated he originally had a red light; however, the light turned green
and he continued straight in the number 1 lane. Vehicle 1 had been in the left turn lane to go west
onto S 21st Street from northbound Benson. Driver 1 stated he had a green light and began his turn.
Driver 2 stated he also had a green light and continued straight.
There were no independent witnesses.
Both drivers were identified by WA DL's.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc Adam/1254 6-23-2023/Renton PD
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.ADAM 06-23-23 12:22 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 6/24/2023 1:09:35 PM
BADGE OR ID# 1254 OR]# WA0171300 TIME POLICE DISPATCHED 11:12 PM TIME POLICE ARRIVED',11:18 PM
PART Ei PAGE IT]OF
REPORT NO. ED73326 CASE# 23-7111 DATE AND TIME 06/22/23 23:08
OF COLLISION
IV
South 21 st St
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