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COLLISION REP FIT 1591971
CASE 23-1927 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
i TRIBAL UNITS 01 STRUCK ROADWAYD/TCH
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 02 - 17 - 2023 0939 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 2500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 800 00 FMILES EET ❑ S ❑ E ❑ SE 5TH ST
2 3 29
MOTUNIT O1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
6� LAST NAME PATTON FIRSTNAME ANTOINE MIDDLE D 1 2 31
INITIAL
STREET ❑ 32741 19TH PL S APT K102 CITY FEDERAL WAY ST WA 2jp, 980039446 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
D-O B 10 - 07 - 1997 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H U SE CLASS 7 I UNKRE OF INJURIES 2❑
❑LICENSE CDD8924 sTArI WWAvrN# 5XXGT4L31GG068738 3
10❑ PI ATE#
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ vIN#' VIN#
FRO❑M TO
34
13❑ VEH.YEAR 2016 MAKE KIA MODEL OPTIMA STYLE VEHICLE TOWED 0 TOO
ffBLIN TQVWkkRS yOS❑ENO
DAMAGE ILJI tSA1Vi�6
REGISTERED OWNER INFO LARAEHAMIM 13445 MLKJR WAYS#D208 SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT & LI POCV# O1'OP
vewcLE CHARGE BOTTOM ❑ 36
LEGALLY YES NO CITATION# 3AO081038,3AO081038, NO VALID OPER LICENSE WITH
15❑ T Fl-
1,1 MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑ ❑ PEDESTRIAN ❑ ❑
VEHICLE CYCLE OWNER YES NO
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs❑NOF YEs❑NO❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ &POINSULICY#E CO
IN EFFECT 9TOP 5
vE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N`L J
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED35843
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1927
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SALAS M/GAEL
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2534800106 SEX' U MMDDYYYY -❑
PASSENGER [:]WITNESS
POS. USE ICLASS
J WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMETCLAINJURY RYSS NATURE OF INJURIES
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYV
PASSENGER ❑WITNESS❑ UNIT# SEAT I AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 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'
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 02-17-23 12:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 212112023 10:21:49 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 9:40 AM TIME POLICE ARRIVED',9:42 AM
PART I PAGE IT]OF 4�
REPORT NO. ED35843 CASE# 23-1927 OF COLLISION
02/17/23 09:39
OF CbLLI510N
NARRATIVE
CC
Within the city limits of Renton/King/Wa I responded to a single vehicle roll over near the 2500 block
of Maple Valley Hwy.
Unit 1 driver ID'd by his matching picture WA-ID was laying next to a car of its roof and covered up
with a blanket. Bystanders had helped him out of the car and covered him up waiting for Renton Fire.
Renton Fire treated and transported unit 1 to VMC for additional checks.
After reviewing tire marks, curb strikes, and the location that rolled unit 1 over, based on my training
and experience, unit 1 was traveling at a speed too fast for conditions, lost control of his vehicle in the
"S curves of Maple Valley Hwy, slid across the 2 head on lanes of traffic, hit the curb going up and
over in a partial broad slide, went into soft wet dirt and leaves tripping the car where it came to rest on
its roof line.
I cited unit 1 via complaint Ref RCW 46.61.400 Sppeds too fast for conditions, RCW 46.30.020 No
insurance and RCW 46.20.015 Driving with NO Valid Operators Licesne with ID (NVOL 2nd)
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
PAGE 3 OF 4
REPORT NO. ED35843 CASE# 23-1927 DATE AND TIME 02/17/23 09:39
OF COLLISION
CI#S
unit 1
rx w
t`45�
Emit 1
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PAGE 4 OF 4