HomeMy WebLinkAbout23-1353 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-1353 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 5 6 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#
cawsloN 02 - 01 - 2023 0855 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
S 3RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ W e MORR/S AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4082346116 0 11
30
6� LAST NAME FERNANDEZ FIRSTNAME NATHAN MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 225 LOGAN AVE S APT 183 CITY RENTON ST WA ZIP' 980572073 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 3 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� 8BFN462 sTATI CA vIN# JNI6JORR1HM407307
-- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. To
TRLR. TRLR 1 5 33
12 0 0 VIN#j VIN#
ROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34
13 2 2017 INFI QX56 DAMAGE vEs 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO LORIKRAUSS 12358 ARROYO DEARGUELLO SARATOGA CA 95070 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO AMICA 9302463173 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2533925999
16 a
LAST NAME MCLAUGHLIN FIRST NAME JORDAN MIDDLE IB
INITIAL
17❑ STREET ❑', 5803 162ND ST CT E CITY' TACOMA ST WA ZIP 98446 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 LICENSE# STATE WA SEX M MMDDW 08 _ 04 1982 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE 7967PH rare.WA VIN# 5NMSG73D79H272019
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2009 MAKE HYUN MODEL SANTA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO GERALD JENSON 5308162ND STREET CTE TACOMA WA 98446 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. STOP 5
'E""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N 6
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. ED30442
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1353
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 02-01-23 09:40 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 2/1/2023 4:59:37 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 8:56 AM TIME POLICE ARRIVED',9:01 AM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED30442 CASE# 23-1353 OF COLLISIONO2/01/23 08:55
NARRATIVE
unit 1 gry suv sb morris 2/gry suv eb s 3rd lane 1
RTF
Information/Insurance only
Within the city limits of Renton/King/Wa I responded to a 2 car crash at the intersection of Morris Ave
S/ S 3rd St.
I contacted the driver of unit 2 who told me he was eastbound lane one S 3rd St when unit 1 crashed
into the side of his vehicle. Unit 2 did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 who told me he was southbound on Morris Ave S and said that unit 2
crashed into the front of him. He did not complain of injury and damages required a tow truck.
There were no witnesses to corroborate either story and each story was feasible.
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 2/1/2023
PAGE 3 OF 4
REPORT NO. ED30442 CASE# 23-1353 DATE AND TIME 02/01/23 08:55
OF COLLISION
is
lw
PAGE 4 OF 4