HomeMy WebLinkAbout24-2474 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-2474 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 03 - 1-- 2024 1000 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD M4700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e DUVALL AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252604063 0 11
30
6� LAST NAME CHAO FIRSTNAME SOPHIA MIDDLE C 1 2 31
INITIAL
STREET ❑, 15452 SE RENTON/SSAQUAH RD CITy RENTON ST WA Zjp, 980596204 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 4 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
,OF
P1 ATNES# BNE3731 sTAr WAuN# 3N10E2CP5HL371059
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 3 ] 34
13 2017 NISS VERSA DAMAGE YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO SOPHIA CHAO 15452 SERENTON ISSAQUAH RD RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE INSURANCE CO STATE FARM 2796046-D22.47C 3 4
IN EFFECT &POLICY# 9TOP
VE"'CLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2533898869
16 a
LAST NAME JOHNSON FIRST NAME MICHELE MIDDLE R
INITIAL
17❑ STREET ❑', 1216 S 201ST ST CITY' SEATAC ST WA ZIP 981983319 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVER # STATE WA ]SEX IF M D.O.B. 07 25 _ 1993 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE ADD8968 TAre WA VIN# KNDJT2A23B7229001
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2011 MAKE KIA MODEL SOUL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO JAMES JOHNSON 1782492ND AVE EPUYALLUPWA98375 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 924002968IN
VEHICLe ❑ C[ CITATION# CHARGE C�Ql
LEGALLY YES N
25 s a
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. EE57083
COLLISION REPORT III III III III III 111
1591972 CASE# 1 24-2474
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 NJURY
POS. NATURE OF INJURIES
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 in a parking lot on the north side of the 4700 blk of NE Sunset BLVD, facing south,
intending to turn left (eastbound) onto NE Sunset BLVD. Unit 2 was traveling westbound in the 4700
blk of NE Sunset BLVD entering a left turn lane. Vehicles backed up from the stop light at Duvall
AVE NE, in the right 2 of 3 westbound lanes, had stopped and left space for Unit 1 to make this turn.
Unit 2 was approaching in the left 3rd westbound lane. Believing they were being given an indication
the turn was safe to complete, Unit 1 began the left turn crossing over the right 2 lanes and entering
the 3rd left turn lane occupied by Unit 2. Unit 1 pulled into the path of Unit 2, traveling with the right of
way, and the front end of Unit 2 impacted the driver's side of Unit 1. Unit 1 sustained moderate/heavy
driver's side damage with airbag deployment. Unit 2 sustained moderate but disabling front end
damage. Both vehicles towed by Bankers Tow.
This report is to document the collision and Unit 1's turn into the path of Unit 2 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 03-06-24 11:03 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 31712024 6:08:15 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED', 10:04 AM TIME POLICE ARRIVED 10:09 AM
PART I PAGE IT]OF
REPORT NO. EE57083 CASE# ' 24-2474 DATE AND TIME 03/06/24 10:00
OF COLLISION
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