HomeMy WebLinkAbout23-9254 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9254 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 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# ❑
cowsloN 08 - 1-- 2023 1153 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N SOUTHPORT DR BLOCK NO. e✓ 1100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e PARKAVEN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2062288455 0 11
30
6� LAST NAME RUNNING FIRSTNAME JULIE MIDDLE M 1 1 2 31
INITIAL
STREET ❑1 12240 8TH AVE S C{Ty BURIEN ST WA 2jp, 981682205 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO,/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'F MIDI Y' 11 — 03 — 1979 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 ATNES# BTM7412 sTAr WAu N# JTMRJREV4JD159143
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 2 2018 TOYT RAV4 UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 4670912C1647B 3 4
IN EFFECT &POLICY# 9TOP
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ LE STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES,/ NO D:2068229138
16 a
LAST NAME LUI FIRST NAME YAN MIDDLE I Y
INITIAL
17❑ STREET ❑', 9355 MA AVE S CITY SEATTLE ST WA ZIP 981185433 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 RRS LDI IVE STATE WA SEX M M .C.B. 03 _ 27 1951 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE 795ZLS TAre WA vIN1 1HGCF86642A168809
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GoI
VEH D
YEAR 2002 MAKE HOND MODEL ACD4D STYLE $D AMAGE TOWED NOO✓ BLIN TOWED BY vHYES NO,� 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 4431486E2647IN 1 9TOP 5
"'LE ❑ N`LJ
,.I— CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES s a
=WARD
AME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26 11528 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88777
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9254
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
PM 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'
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.
S.WOODWARD 08-12-23 06:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 8/13/2023 12:48:34 PM
BADGE OR ID# 11528 ORI#' WA0171300 TIME POLICE DISPATCHED 12:02 PM TIME POLICE ARRIVED',12:07 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED88777 CASE# 23-9254 OF COLLISION
08/12/23 11:53
OF CbLLI510N
NARRATIVE
On 08-12-23, at approx. 1207 hrs, I arrived on scene at 1100 N. Southport Dr to investigate a
reported two car non-injury collision.
On arrival, I contacted both vehicles and their drivers. I confirmed there were no injuries and no
medical attention was needed. Both drivers provided all necessary and current paperwork.
When asked, Driv 1 said she was eastbound on N. Southport Dr, just past Park Ave N, in the number
2 lane. Her husband was following in a separate vehicle behind her. All of a sudden, a black Honda
CRV came speeding up beside her, also driving east, but he was in the westbound turn lane for
westbound traffic (across the double yellow line and going into oncoming traffic).
The CRV moved over then, starting to merge into her lane, and to avoid a collision, she moved over
into the #1 lane. When she did so, the front corner of her vehicle struck the side panel of a black car
that was next to her. After the impact, both her and the black sedan pulled over and stopped. The
CRV didn't stop for them and was last seen turning south on Garden Ave N. She didn't get a
description of that driver and said it didn't have a license plate.
When asked, Driv 2 said he was driving east in the number 1 lane when the white car next to him
suddenly moved over and struck his car. He didn't see anything else and had no further information.
The damage to both vehicles was consistent with both stories and supported their accounts. There
was just a minor scrape to Veh 1 and moderate scraping to Veh 2.
1 provided an exchange of information form to both drivers and cleared the scene.
Nothing further.
PAGE 3 OF 4
REPORT NO. ED88777 CASE# ' 23-9254 DATE AND TIME 08/12/23 11:53
OF COLLISION
Lake Wash.81vd..N
V
Park Ave:;N
Garden Ave.N
PAGE 4 OF 4