HomeMy WebLinkAbout23-1831 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 23-1831 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 02 - 1-- 2023 1011 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
WILLIAMS AVE N BLOCK NO. e✓ 425
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 325 00 FEET MILES e S B W e "MST
ST
1 $ 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:4253452562 0 11
30
6� LAST NAME RIVERA FIRSTNAME DAMION MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 425 WILLIAMS AVE N CITY RENTON ST WA ZIP 980575453 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs No YES No
8❑ LRIIVERCENS # STATE WASEX'M MM D Y' 03 — 31 — 1981 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATNES# BQZ3305 sTAr WAu N# WDDGF54X58F017117
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FR.. ro
TRLR. TRLR. 0 0 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2008 MAKE MERZ MODEL C STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO DAMION RIVERA 425 WILLIAMS AVE N RENTON WA 980575453 D:4253452562 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 3 4
14 IN EFFECT INSURANCE PROGRESSIVE 959938148
IN EFFECT &POLICY# � 9TOP
L-A
LEcnLLYLE YES❑NO CITATION# 3AO081032 CHARGE 36
UNSAFE OR IMPROPER BACKING 1 o BorroM
15❑ STANDING 8
MOTOR PEDAL- 'PEDESTRIAN PROPERTY❑ ❑ ❑ [:]LA. / TR PHONE oUNIT VEHICLE CYCLE OWNER E
D:2064464645
16 a
LAST NAME GIRON FIRST NAME DONNA MIDDLE M
INITIAL
17❑ STREET ❑', 513 SW 5TH PL CITY RENTON ST WA ZIP 980572339 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs❑NOF YEs❑NO❑
19 DRIVER'S STATE I WA ]SEX IF I D.Q.B. 09 _ 22 _ 1997 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BYG2579 TAre WA vIN# 3C3CFFCR8HT570839
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2017 MAKE FIAT- MODEL 500 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MARISA MURGA INFANTE 200 SW 5TH PL APT D304 RENTON WA 98057 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. CQ'E""LE
❑ ,J� CITATION# CHARGE io
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. ED35812
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1831
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 02-14-23 11:03 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 212112023 8:41:33 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 10:11 AM TIME POLICE ARRIVED 10:20 AM
PART I PAGE IT]OF 4�
REPORT NO. ED35812 CASE# 23-1831 OF COLLISION
02/14/23 10:11
OF CbLLI510N
NARRATIVE
blk sedan backing from drvway blu mini coupe sb
CC
Within the city limits of Renton/King/WA I responded to a 2 car non blocking crash at 425 Williams
Ave N.
I contacted the driver of unit 2 who told me she was south on Williams Ave S when unit 1 backed into
the front of her car. She did not complain of injury and damages did not require a tow truck.
I conciliated the driver of unit 1 ID'd by his picture WADL. He told me he had backed completely out
of his driveway and was rear-ended/hit by unit 2. He did not complain of injury and damages did not
require a tow truck.
While looking at the location of the damage on both vehicles and the scraping marks running across
the back of the bumper of unit 1 it was my belief that the collision took place while unit 1 was still
backing/underway and not stopped.
I cited unit 1 ref RCW 46.61.605 Improper/unsafe backing two car crash 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 2/14/2023
PAGE 3 OF 4
REPORT NO. ED35812 CASE# ' 23-1831 DATE AND TIME 02/14/23 10:11
OF COLLISION
T Z n is
OZ
PAGE 4 OF 4