HomeMy WebLinkAbout23-7015 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7015 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 06 - 1-- 2023 1435 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
UNION AVE NE BLOCK NO. e✓ 1600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254453202 0 11
30
6� LAST NAME WASSON FIRSTNAME STEVEN MIDDLE R 1 1 2 31
INITIAL
STREET ❑, 1913 VASHON CT NE CITY RENTON ST WA Zjp, 980593813 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10� Pi aT�S� AQT7667 sTATe WAurN# 1GKFK66U66J159629
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR 9 1 33
12 3 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2006 GMC YUKON DAMAGE vEs 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO STEVEN WASSON 1113 VASHON CTNE RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE 987501284 3 4
IN EFFECT &POLICY# 9TOP
VEHICe CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 3A0369663 INATTENTIVE DRIVING 1 o aorrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER
❑ YES 1/ NO D:2065120884
16 a
LAST NAME MARITH FIRST NAME SYDNEY MIDDLE S
INITIAL
17❑ STREET ❑', 3220 NE 26TH CT CITY' RENTON ST WA ZIP 980562446 37
NEW ADDRESS ❑
18E CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED 38
INTERLOCKYES — NOR INTERLOCK YEs I I NoF YES t l NOF,—/]
19 DIVE
{NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE BOL6499 TATe WA VIN1 USE
❑ 41
pLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN It IN#.
VEH YEAR 2012 MAKE TOYT MODEL CAMRY STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO DARARITH MARITH 3220 NE 26TH CT RENTON WA 98056 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATEFARM 512 6065-D11-47IN 1 5VEHICLELLY ❑ CITATION# CHARGE
25 GQ
LEGA YES N`E]
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED72246
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7015
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'
Unit 1 was parked on the east side of the 1600 blk of Union AVE NE facing north. Unit 2 was
traveling northbound in the 1600 blk of Union AVE NE. Unit 1 was attempting to enter traffic from this
parked position onto northbound Union AVE NE. Unit 1 failed to assure that the roadway was clear to
enter traffic and began to pull out into the roadway as Unit 2 was passing. The front driver's side of
Unit 1 impacted the passenger side of Unit 2 causing moderate damage to both vehicles. The front
driver's side wheel of Unit 1 was disabled as a result of the collision and was towed by Bankers Tow.
Driver 1 was cited for Inattentive Driving by not driving with due care and caution to assure the
roadway was clear when entering which was the proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 06-21-23 08:50 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 612112023 10:31:50 AM
BADGE OR ID# 10008 OR]#' ' WA0171300 TIME POLICE DISPATCHED! 2:50 PM TIME POLICE ARRIVED',2:59 PM
PART I PAGE IT]OF 3�
REPORT NO. ED72246 CASE# ' 23-7015 DATE AND TIME 06/20/23 14:35
OF COLLISION
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