HomeMy WebLinkAbout23-468 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE z3-4s8 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 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 - 12 - 2023 0808 17 ❑-= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
DUVALL AVE NE BLOCK NO.
1❑ e✓ ❑
MILEPOST
4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 9TH ST
0 5 29
MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30
6� LAST NAME JUCHMES FIRSTNAME JOSHUA MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 13626 439TH AVE SE CITY NORTH BEND ST WA ZIP, 980459237 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LRIIVERS STATE WA SEX'M MM DAY' 05 — 25 — 1976CENSE 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 7❑ P1 aTNSE C59788W sTAr� WA urN# 5KKMALDE37PY24693
5 TRAILER STATE TRAILER STATE
11
3—LATE# PLATE# ROM To
TRLR. A'RLR. 1 1 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 r 2007 WEST TRUCK DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO JOSH.JUCHMES DBA JOSHUAS TRUCK)13626439THAVESE NORTH BEND WA 98045 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME PARK FIRST NAME SE MIDDLE I,I
INITIAL
17❑ STREET ❑', 7502 129TH PL SE UNIT H102 CITY' NEWCASTLE ST WA ZIP 980561801 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES
t l NO❑
19 DRIVE STATE WA SEX F M D.C.B. 03 _ 23 _ 1973 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BUU2598 TAre I WA VIN# 4T3T6RFV8NU101471
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TIN# IN RLR
#.UIN#. '
VEH YEAR 2022 MAKE TOYT MODEL RAV4 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO HEE SHIN 7502129TH PL BE UNIT H102 NEWCASTLE WA 98056 VEHICLE NO.2
SHADE IN DAGELLAREA
z Cdd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
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. ED26461
COLLISION REPORT III III III III III 111
1591972 CASE# 23-468
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BUACUBURN TAJA
(LAST FIRST,
ADDRESS&PHONE# D.O.B.
2$37$27710 SEX' <) MMDDYYYY. -❑
---------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ �, POS. USE CLASS
NAME
'(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# SEXI D O B
MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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'
u turn pit red/gray
RTF
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
NE 9th St and Duvall Ave NE.
I contacted the driver of unit 1 who told me he believed traffic had been stopped and cleared by the
construction flagger as he was making a U-turn in his dump truck. He was making a left U-turn while
unit 2 had not competently cleared the area and unit 1 clipped unit 2 on the rear passenger side,
essentially PIT-ing her up and onto the sidewalk. He did not complain of injury and damages were
unremarkable.
I contacted unit 2 who told me she was northbound when the dump truck made contact with her car.
She did not complain of injury and damages did require a tow truck.
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 1/12/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 01-12-23 10:31 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 111912023 12:59:34 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 8:09 AM TIME POLICE ARRIVED;8:19 AM
PART I PAGE 2�OF❑
REPORT NO. ED26461 CASE# ' 23-468 DATE AND TIME 01/12/23 08:08
OF COLLISION
nts
PAGE 3 OF 3