HomeMy WebLinkAbout23-8113 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8113 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
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# ❑
GawsloN 07 - 1-- 2023 1638 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 3RD ST BLOCK e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FMILES EET e S ❑ E e RAINIER AVE S
0 4 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYYESA�NO GE THRESHOLD MET PHONE 0 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST zIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10[ PI ATE#
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
rRLR. TRLR 1 3. 33
12 2 5 VIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 1 2015 MERZ GLK350 4W DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vewcLe CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 6
UNIT 02
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
❑VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2062352797
16 a
LAST NAME CALLAHAN FIRST NAME RORY MIDDLE K
INITIAL
17 STREET I❑ 17701 NE 143RD PL CITY' WOODINVILLE ST WA ZIP 980726303 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORT E � 38
INTERLOCK YEs❑No� INTERLOCK YES It1 I NoF t—
YES t l NOV/
19 DRIVER'S STATE WA SEX M I D.C.B. 09 _ 26 _ 1983 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
LICENSE ❑21❑ PLA E# CBE3361 TATE 41
WA vIN# 4S4BRBCC183317038 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2011 MAKE SUBA MODEL OUTBAC STYLE GA VEHICLETOWED TO BLIN TOWEDBY GOV!TN
44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO RORY CALLAHAN 17701 NE 143RD PL WOODINVILLE WA 98072 D:2062352797 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 954360462IN 1 9TOP 5
VEHICLE ❑ OE] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
P.LANTAGNE 12575 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED80078
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8113
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JENSEN ANNA M
(I.P.ST FIRST,
ADDRESS&PHONE#
95 BURNETT AVE S UNIT 419 RENTON WA 980572199 2062352797 SEXi F MMDOYyry 08 - 02 - 1986
PASSENGER Z WITNESS❑'UNIT# 2 PEAT OS 3 AIRBAG 2 RESTR. q EJECT ? 1 HELMET NATURE OF INJURIES
USE CLASS
'1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
P.LANTAGNE 07-15-23 07:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 711612023 2:32:27 PM
BADGE OR ID# 12575 ORI#' WA0171300 TIME POLICE DISPATCHED! 5:00 PM TIME POLICE ARRIVED]5:05 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED80078 CASE# 23-8113 OF COLLISION
07/15/23 16:38
OF CbLLI510N
NARRATIVE
23-8113
On 07/15/2023 at approximately 1700 hours, I, Officer Lantagne, responded to a non-blocking, non-
injury collision which occurred on S 3rd ST in approximately the 100 block, which is located in the
City of Renton, County of King, and the State of Washington. I responded in my fully marked police
vehicle, wearing my patrol uniform.
I arrived on scene and observed Unit#2, a 2011 Subaru Outback with license plates CBE3361 issued
out of Washington State, parked in the Fortune Casino parking lot. I was advised by the driver of Unit
#2, Rory K. Callahan (DOB 09/26/1983), there were no injuries.
Callahan told me the following: Callahan had just made a right turn from Rainier AVE S onto S 3rd
ST. As Callahan drove eastbound on S 3rd ST, a blue Mercedes SUV made a left turn from the
Safeway parking lot onto S 3rd ST. The blue Mercedes pulled into Callahan's lane and struck the left
rear bumper of his vehicle. The damage to the Mercedes would have been on the right front bumper.
The driver of the Mercedes left without making any attempt to exchange information.
I observed the damage to the vehicle and other physical evidence was consistent with the statements
made by Callahan. Unit#2 had minor damage to the left rear bumper which consisted of a large
scrape and blue paint transfer.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Callahan.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1815 hours on 07/15/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. ED80078 CASE# ' 23-8113 DATE AND TIME 07/15/23 16:38
OF COLLISION
SW"Sunset Blvd
Unit#1
S3rdSt
Case#23-8113'
Unit#2
Rainier Ave S Not to Scale
P. Lantagne;#12575
PAGE 4 OF 4