HomeMy WebLinkAbout23-209 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE# z3-zos 2
INTERSTATE CITY STREET FIRE
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 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 01 - 1-- 2023 1455 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
WILLIAMS AVE S
e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e S 2ND ST
0 1 29
MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE 30
6� LAST NAME DOBSON FIRSTNAME VICKI MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 821 N IS ST CITY RENTON ST WA ZIP 980575602 2
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10❑ Pi aT�S� CCK9781 sTArI WAvrN# WDBUF56X576067868
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FR.. ro
TRLR. A'RLR. 1 5 33
12❑ VIN#j UIN#
FROM r0
VEH.YEAR 2007 MAKE MERZ MODEL E STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13❑2 DAMAGE YES NO ✓ YES
❑ NO✓
REGISTERED OWNER INFO VICKI DOBSON 8211 1ST ST RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
vEwcLe CHARGE 1 5 36
LEGALLY ve8❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING 8 7 6
UNIT a2 VEHICMOTOLE ❑ CYCLE ❑ PEDESTRIAN ❑PEDAL- ✓ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME DAVIS FIRST NAME BARBARA MIDDLE IL
INITIAL
17❑ STREET ❑', 130 MAIN AVE S#127 CITY RENTON ST WA ZIP 98057 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK yEEst
III I I NOF YES
t t- l NO❑
19 DRIVE # STATE SEX F Mr D.C.B. 04 19 _ 1939 39
ON DUTY STATUS 3 AIRBAG RESTR EJECT , HELMET I INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS KNEE HIP
El 41
21❑ LICENSE I TArE I IN1
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 Q 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
M.LEVERTON 2517 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED23876
COLLISION REPORT III III III III III 111
1591972 CASE# 23-209
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.
M.LEVERTON 01-05-23 03:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
S.MORR/S 2613 111112023 8:26:30 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 2:55 PM TIME POLICE ARRIVED i 2:55 PM
PART I PAGE IT]OF 4�
REPORT NO. ED23876 CASE# 23-209 OF COLLISION
01/05/23 14:55
OF CbLLI510N
NARRATIVE
ped w2e north side on walk sig wht sedn hits ped low speed
RTF
Within the city limits of Renton/King/WA I responded to a car v ped at S 2nd St and Williams Ave S.
I arrived to find Renton Fire on scene tending to a ped laying in the crosswalk and white sedan
stopped just behind her.
I contacted the driver of unit 1 who told me she was going to make a right turn from southbound
Williams Ave S to S 2nd St. She told me her light was red and she looked left but did not see the Ped
crossing until she made contact with the Ped. Damages were unremarkable and she did not
complain of injury.
I contacted the Ped who told me she was walking north side of S 2nd St back to her place. She
began to cross in the crosswalk after the walk signaled indicated when she was hit by unit 1. She
was treated and released on scene. Before I was complete with my information exchange she was
ready to leave. She was up and walking around. She complained of knee/hip pain.
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 1/5/2023
PAGE 3 OF 4
REPORT NO. ED23876 CASE# 23-209 DATE AND TIME 01/05/23 14:55
OF COLLISION
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