HomeMy WebLinkAbout23-2242 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-2242 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 N E IN CITY# ❑
cowsloN 02 - 1-- 2023 1138 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 41ST ST BLOCK NO. e✓ 600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 450 00 FEET MILES e S ❑ W e LIND AVE SW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2015196935 0 11
30
6� LAST NAME GORE FIRSTNAME CLELIA MIDDLE I 1 F 4 31
INITIAL
STREET ❑, 836 W ARMOUR ST CITY SEATTLE ST WA ZIP 981192232 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CAY6527 sTArI WAurN# 5TDHBRCHXMS535973
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34
13 2 2021 TOYT HIGHLA DAMAGE vEs ONO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO MICHAEL GORE 1741 W MERCER WAY MERCER ISLAND WA 98040 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO ALLSTATE 817 917 240 4
IN EFFECT &POLICY#VEHCLE CHARGE36
LEGALLYYES❑NO❑ CITATION# 3AO081053 FAIL YIELD LEFT TURN MOTOR <1�3
orrow
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065511698
16 a
LAST NAME LAGUNAS FIRST NAME JODY MIDDLE I B
INITIAL
17❑ STREET ❑', 4532 S 300TH PL CITY' AUBURN ST WA ZIP 980012988 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[ D IVEW #
ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES 40
USE CLASS CHEST
21❑ LICENSE A/Z2306 TArE WA VIN# WDBKK49F91F221093
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2001 MAKE MERZ MODEL SLI( STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO JODY LAGUNAS 4532 S 300TH PL AUBURN WA 980012988 D:2065511698 VEHICLE NO.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 967911762IN 9TOP 5
'E""LE ❑ Nu,J CITATION# CHARGE io BOTTOM
LEGALLY YES
25 ' e
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. ED38475
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2242
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 FIRST 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'
blk suv 1 It to ikea wht coupe lane 2 eb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash near the 600 block of
SW 41 st St.
I contacted the driver of unit 2 who told me she was eastbound in lane 2 on SW 41 st st when unit 1
made a left turn colliding into her. She did complain of chest pain. She was checked and released by
Renton Fire on scene. Damages required a tow truck. Unit 2 told me unit 1 said she made the turn
because she could not see her car.
I contacted the driver of unit 1 who said she was making a left turn into the Ikea parking lot and
crashed into unit 2. She did not complain of injury and damages required a tow truck.
I cited unit 1 ref RCW 46.61.185 FTYROW-Left Turn 2 car injury 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 2/24/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-24-23 12:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
S.MORR/S 2613 31112023 8:57.14 AM
BADGE OR ID# 2517 ORI#' WA0171300 TIME POLICE DISPATCHED 11:38 AM TIME POLICE ARRIVED 11:45 AM
PART I PAGE IT]OF 3�
REPORT NO. ED38475 CASE# ' 23-2242 DATE AND TIME 02/24/23 11:38
OF COLLISION
- 11£
PAGE 3 OF 3