HomeMy WebLinkAbout23-9546 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 23-9546 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 CITY#
cawsloN 08 - 19 - 2023 1003 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N BLOCK NO. e✓ 1000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 10TH ST
0 4 29
MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE 30
6� LAST NAME MITCHELL FIRSTNAME JENNIFER MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 9916 S 229TH PL CITY KENT ST WA ZIP 98031 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ 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❑ P1 aT�S� BfH5983 sTArI WAurN# JF2GFABCXJH254452
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR. TRLR. 1 3 33
12❑ VIN#' UIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 3 2018 SUBA OUTBA SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI V INSURANCE INSURANCE CO STATE FARM#L24 0771-B14.471 3
IN EFFECT &POLICY# 9TOP
vewcLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�NiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:8144319022
16 a
LAST NAME CARLUCCI FIRST NAME STEPHEN MIDDLE A
INITIAL
17 STREET❑ NEW ADOREss❑' 11059 ROWAN RD S CITY' SEATTLE ST WA ZIP 98178 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVE #
ON DUTY STATUS 1 AIRBAG RESTR EJECT 2 HELMET 7 INJURY 6 NATURE of INJURIES ❑ 40
USE CLASS SORE L SHOULDER/ARM
❑21❑ TArE 41
LICENSE YIN# 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 4 4 J.CARSTENSEN 11648 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED93582
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9546
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HANSEN DANIEL
(IAST FIRST,
ADDRESS&PHONE# D O.B.
4253308037 SEX' U MMDDYYYY -❑
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
'(LAST,FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYV
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.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 8/19/23 at about 1004 hours I was working uniformed patrol in my unmarked patrol vehicle when I
was dispatched to collision at Logan Ave N/ N 10th ST in the City of Renton, King County, WA.
I arrived and contacted Unit 1, who relayed the following:
Unit 1 was driving southbound on Logan Ave N approaching N 10th ST. Unit 1 had a green light (not
arrow) to make a left turn onto N 10th ST. As Unit 1 committed to the turn, Unit 1 noticed Unit
2/Bicyclist about to collide, but it was too late. Unit 2 collided with Unit 1. There were minor scratches
on the right rear of Unit 1's vehicle.
I contacted Unit 2/Bicyclist, who relayed the following:
Unit 2 was riding his bicycle northbound on Logan Ave N approaching N 10th ST. Unit 2 had a green
light so he continued through the intersection. Unit 1 turned left in front of Unit 2. Unit 2 collided with
the rear end of Unit 1. Unit 2 was knocked off his bicycle, landing on his left arm/shoulder, causing
pain.
Renton Fire assessed and cleared Unit 2 on scene.
I talked to a witness, who relayed the same story as both Unit 1 and Unit 2.
1 gave both parties a business card with the case number.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.CARSTENSEN 08-19-23 10:55 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 812812023 10:20:51 AM
BADGE OR ID# 111648 OR]# WA0171300 TIME POLICE DISPATCHED 10:03 AM TIME POLICE ARRIVED',10:05 AM
PART I PAGE IT]OF 3�
REPORT NO. ED93582 CASE# ' 23-9546 DATE AND TIME 08/19/23 10:03
OF COLLISION
Not to Scale
Unit;
N 10th ST
r
z
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