HomeMy WebLinkAbout23-8392 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8392 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑
COLLISION: 07 — 1—— 2023 1043 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SHATTUCKAVES
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2069028381 0 11
30
6� LAST NAME LUCKETT FIRSTNAME OSHEAY MIDDLE O 1 2 31
INITIAL
STREET ❑, 5134 S 170TH ST CITy SEATAC ST WA ZIP 98188 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 6 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� BQN6388 sTAr� WAVIN# 2C3AA43R75H529133
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2005 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 3 TOWED By GOVT.VEHICLE 34
13 4 CHRY 300 SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILIT INSURANCE INSURANCE CO THE GENERAL 53-WA-9747153 4
IN EFFECT &POLICY# 9TOP
VEHicLE 5 36
LEGALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2537775061
16 a
LAST NAME JOHNSON FIRST NAME AARON MIDDLE ,/
INITIAL
17❑ NEW STREETREs7 4518 324TH ST E CITY EATONVILLE ST WA ZIP 98328 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK yEs❑NOF YEs❑NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 04 07 1978 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ LICENSE I PLA E# BEB3105 TArE WA vIN# 1ZVBP8CU1D5235482 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GoI
VEH D
YEAR 2013 MAKE FORD MODEL MUSTAN STYLE $D AMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE 950424339IN STOP 5
--E ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' a
7JACOB
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26WEBER 12532 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84860
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8392
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JONES RENEEV/A L
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
$EATAC 2065786270 SEX' F MMDDYYYY 02 - 20 - 1993
PASSENGER I�I WITNESS R(UNIT# ' 1 FOS 7 AIRBAG'6 RESTR. 4 EJECT ? 1 HELMET LASS NATURE of INJURIES
L�!1 USE 2 CLASS :1
NAME
(LAST,FIRST,MIDDLE INITIAL) LEUTH HONESTY M
ADDRESS&PHONE# D O 8
SEATAC 9999999999 SEX IF MM�Dvvvv O6 _ 12 _ 2015
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER RV WITNESS UNIT# 1 POS. 9 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) JONES SHAKIETHA L
AppRESS&PHONE# $EATAC 2067171986 SEX MMDDYYYY 03 14 _ 1992
. F D.O.B. _
PASSENGER WITNESS UNIT# ! 1 SEAT 3 AIRBAG 6 RESTR. 4 EJECT 1 HELMET 2 NJURY 1 NATURE OF INJURIES
❑ POS. USE CLASS ----�
NARRATIVE'
On 07/22/2023 at approximately 1054 hours I was dispatched to a report of a blocking accident at the
intersection of Airport Way, and Shattuck Ave S. I arrived on scene after other officers, who had
already collected information and stories from the involved drivers. Driver 2 advised he was traveling
eastbound of Airport Way crossing Shattuck Ave S when Driver 1, who was traveling westbound on
Airport Way made a lefthand turn towards southbound Shattuck Ave S, and the vehicles collided.
There was no protected turn/turn arrow for Driver 1's light, and they both had green lights. Both
parties' stories were consistent with each other. There were no injuries, vehicles were towed via
owner's request.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JACOB WEBER 07-22-23 11:54 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:25:23 PM
BADGE OR ID# 12532 OR]# WA0171300 TIME POLICE DISPATCHED 10:54 AM TIME POLICE ARRIVED',11:05 AM
PART Ei PAGE IT]OF
REPORT NO. EU84800 CASE# 23-8382 DATE AND TIME 07/22/2310:43