HomeMy WebLinkAbout22-13593 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 22-13593 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 7 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.. 12 - 1-- 2022 0742 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
S 26TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e SHATTUCK CT S
0 1 29
UNIT MOTOR
Z PEDAL-
❑ YESA,GEE NHORESHOLD MET PHONE 0 9 30
6� LAST NAME MERIN FIRSTNAME JONATHAN MIDDLE G 1 2 31
INITIAL
STREET ❑ 914 S 30TH P! CITY RENTON ST WA ZIP 980555030 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BV61446 sTArI WAurN# 5FNYF6H39KB046420
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE J 9 34
13 2 2019 HOND PILOT DAMAGE YES NO MEYER YES[:] NO✓
REGISTERED OWNER INFO JONATHAN MERIN 914 S 30TH PL RENTON WA 980555030 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 940968364 <�3
4
IN EFFECT &POLICY#VEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# TTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�NiT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ No D:2533911395
16 a
LAST NAME SHINAUL FIRST NAME ALLIYAH MIDDLE M
INITIAL
17❑ STREET ❑', 911 S 30TH PL CITY RENTON ST WA ZIP 980555031 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 DRIVER'S STATE WA ]SEX IF D.C.B. 12 _ 18 _ 1998 39
LICENSE# MMDDYY
WELMET INJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG,2 RESTR 4 EJECT '1 USE CLASS SHOULDER ❑
21❑ LICENSE I CAS3687 TAre WA vIN# 1N4AL21E79N402802
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2009 MAKE NIS6 MODEL ALTIMA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO ALLIYAHSHINAUL911S30THPL RENTONWA98055 VEHICLE NO.2
SHADE DA GEbAREA
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 6051589635IN IGQ
5
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED19082
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13593
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'
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.
M.LEVERTON 12-23-22 10:21 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 1212712022 1:17:22 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED'I 7:42 AM TIME POLICE ARRIVED',7:46 AM
PART I PAGE IT]OF 4�
REPORT NO. ED19082 CASE# 22-13593 OF COLLISION
12/23/22 07:42
OF CbLLI510N
NARRATIVE
unit 2/wht sedan slid out in ice crooked in road unit 1 blk suv slid in ice into back of
RTF
Within the city limits of Renton/King/WA I responded to a 2 car blocking injury crash near the
intersection of S 26th St at Shattuck Ct S.
Unit 2 told me she was attempting to go up hill in extreme ice conditions without success, spinning
out and stopping on the north side of 26th now stuck. She said unit 1 slid in the ice coming down hill
and crashed into her. She did complain of injury and damages did require a tow truck. Renton Fire
responded to treat/release on scene unit 2.
Unit 1 told me he was attempting to get to work westbound on 26th when he started sliding in
extreme ice conditions hitting unit 2. He did not complain of injury and damages required a tow truck.
Both vehicles a Renton Ambulance and Renton Police Tahoe were also stuck and had to wait for a
sand truck to get out of the scene location. The tow driver was unable to move either vehicle until the
roads were sanded/partially cleared.
Information/Insurance only
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 12/23/2022
PAGE 3 OF 4
REPORT NO.! ED19082 CASE# 22-13593 DATE AND TIME 12/23/22 07:42
OF COLLISION
I I R
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