HomeMy WebLinkAbout24-1493 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-1493 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
Ct ELISION' 02 - 10 - 2024 2151 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N SOUTHPORT DR BLOCK NO. e✓ 1300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SB 1405 ON-RAMP
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064062477 0 4 30
6� LAST NAME SAMAS FIRSTNAME DANNY MIDDLE J 1 2 31
INITIAL
STREET ❑ 424 211 TH AVE NE CITY SAMMAMISH ST WA ZIP 980743942 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 9 EJECT 1 HELMET U E 2 1 CLASS NATURE OF INJURIES 2❑
3
10[1Pi ATNES# AGR6453 sTAr WAV N# JTEDC3EHXC2005543
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#I
FROM TO
VEH.YEAR 2012 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 3 5 TOWED BY GOVT.VEHICLE 34
13 4 TOYT HIGHLA SV DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO JENNIFER SA.,3424211THAVE NE SAMMAMISH WA 98074 VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 LIABILITY INSURANCE PEMCO CA2051048
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE to BOTTOM 5 36
LECALLv YES❑NO❑ CITATION# 5
15❑ STANDING 8 6
T a2 VE MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5093819380
16 2
LAST NAME SEVERSON FIRST NAME ANNIKA MIDDLE E
INITIAL
17 STREET❑ NEW ADOREss❑' 6721 W GREENWOOD RD CITY SPOKANE ST WA ZIP 99224 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK v�Es No� YEs NDF
19[—] LICENSE# STATE WA SEX F M D.O.B. 12 _ 28 _ 2007 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# 9GGP117 TArE 41
CA VIN# 1FMC000N3PUA42258 1
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2023 MAKE FORD MODEL ESCAPE STYLE SI/ VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HERTZ VEHICLES LLC 177 S AIRPORT BLVD SAN FRANCISCO CA 94080 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO USAA CIC0366651027102IN IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE52218
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1493
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 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'
On 02/10/2024 at 2155 hours I was dispatched to a collision at the 1300 block of N Southport Dr in
the City of Renton, King County, Washington.
Upon my arrival I saw Unit 1 had damage to the front passenger side bumper and Unit 2 had damage
to the rear passenger side wheel well, with the rear passenger side wheel bent inwards.
The driver of Unit 2 said that she was traveling Westbound in the lefthand turn lane with a green
arrow. Driver 2 stated that she performed a lefthand turn to proceed South on i405 at the on-ramp
when Unit 1 entered the intersection. Driver 2 stated that the front passenger side bumper of Unit 1
made contact with the rear passenger side wheel well of Unit 2, causing the vehicle to spin and come
to a rest at the entrance to the on-ramp.
The driver of Unit 1 stated that he was traveling East on N Southport Dr approaching the 1300 block.
Driver 1 stated that he was unsure if he had a red light or not when he entered the intersection. Driver
1 stated that when he entered into the intersection he was unable to stop or move to avoid Unit 2 and
the front passenger side bumper of Unit 1 made contact with the rear passenger side wheel well of
Unit 2.
Unit 1 was still operable and was able to be driven away by Driver 1. Unit 2 was rendered inoperable
due to a bent wheen and possible broken axle, and was towed by Gene Meyers to their tow yard.
Both drivers were provided with an exchange of information form.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 02-10-24 11:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 2/21/2024 1:30:17 AM
BADGE OR ID# 112509 ORI#' WA0171300 TIME POLICE DISPATCHED'; 9:55 PM TIME POLICE ARRIVED 10:00 PM
PART I PAGE IT]OF 3�
REPORT NO. EE52218 CASE# 24-1493 DATE AND TIME 02/10/24 21:51
OF COLLISION
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