HomeMy WebLinkAbout23-834 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED28178 170
27
COLLISION REP FIT 1591971
❑ ✓❑ FIRE RESULTED ❑ CASE 23-834 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
cowsloN 01 - 19 - 2023 1434 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BRONSON WAY N BLOCK NO. e✓ 1222
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FMILES EET e S ❑ E e GARDEN AVE N
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259028256 0 11
30
6� LAST NAME BENDIRIBA FIRSTNAME NICKSON MIDDLE S 1 1 2 31
INITIAL
STREET 01 2705 NE 6TH PL CITY RENTON ST WA 21P 980563764 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YEs No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CFE5602 sTATI WA urN# JHtRD1870YC059789
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM To
TRLR. TRLR 1 3 33
12 3 0 VIN#' VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2000 HOND CR-V DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO NI 01 BENDIRIBA 2705 NE 6TH PL RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 6119-16.99.09 3 4
IN EFFECT &POLICY# 9TOP
❑ LEGA LE CHARGE 1 5 36
15 2 srq,1^�,o1 YES❑NO❑ CITATION# 3A0081015 FAIL YIELD PRIVATE RD MOTOR o aorrob
UNIT MOTOVEHIR
CYCLE ❑ PEDESTRIAN ❑ PROPERTY
ROWNER RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME FUENTES FIRST NAME NATHAN MIDDLE I D
INITIAL
17❑ STREET ❑', 135 W PRAIRIE ST CITY' SEQUIM ST WA ZIP 983823784 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 09 _ 10 _ 1989 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BZN9174 TATE WA VIN# YV1MK672892146258
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2009 MAKE VOLV MODEL C30 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO NATHAN FUENTES 135 W PRAIRIE ST SEQUIMWA98382 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 71172185IN STOP 5
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL io BOTTOM
0(
LY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED28178
COLLISION REPORT III III III III III 111
1591972 CASE# 23-834
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 01-19-23 03:10 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 112512023 9:40:05 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 2:35 PM TIME POLICE ARRIVED:2:45 PM
PART I PAGE IT]OF 4�
REPORT NO. ED28178 CASE# 23-834 OF COLLISION
01/19/23 14:34
OF CbLLI510N
NARRATIVE
unit 1 biege suv It att 1222 lane one open slv 2 coupe lane 2
CC
Within the city limits of Renton/King/WA I responded to a 2 car crash near the 1200 block of Bronson
Way N.
I contacted the driver of unit 2 who told me he was west on Bronson lane #2 when unit 1 pulled out in
front of his car causing contact and damage. He did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 2 ID'd by picture WADL. He told me was making a left turn from the
1222 Bronson parking lot shopping area. He told me traffic in lane 1 was stopped and allowed him to
proceed, but he hadn't cleared lane 2. As he pulled into traffic he crossed the path of unit 2. He did
not complain of injury and damages did not require a tow truck.
I cited unit 1 ref RCW 46.61.205 FTYROW when merging into traffic from a private drive via
complaint.
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 1/19/2023
PAGE 3 OF 4
REPORT NO. ED28178 CASE# ' 23-834 DATE AND TIME 01/19/23 14:34
OF COLLISION
Aff
ism
ns
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