HomeMy WebLinkAbout23-3098 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-3098 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 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 03 - 1-- 2023 0751 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S GRADY WAY BLOCK NO. e✓ 355
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 135 00 FMILES EET e S ❑ E e L AVE S
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 8 30
LAST NAME MARTINS BOECHAT MCLAUGHLIN FIRST NAME CAMILA MIDDLE N
6 INITIAL 1 1 2 31
STREET ❑, 11720 SE 165TH ST CITY RENTON ST WA ZIP 980585349 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 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 1❑ PI ATE 14 BBA0881 STATE WA V N# JHLRD78834CO39820
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
—1 1TRLR. TRLR $ 7 33
12 VIN#' VIN#
ROM TO
VEH.YEAR 2004 MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GO VT.VEHICLE J 9 34
13 2 HOND CR-V DAMAGE YES NO �OEYER YES❑ NO✓
REGISTERED OWNER INFO MATTHEW MCLAUGHLIN 2300 JEFFERSON AVE NE APT H23 RENTONWA98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO SAOE. 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3AO081083 INATTENTIVE DRIVINGMOTO I o eorrom
15❑ STAIN.D'ING 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ riWNFRRT ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME EDORA FIRST NAME RAQUEL MIDDLE I C
INITIAL
17 STREET I❑ s❑' 2110 MONTEREY CT SE CITY RENTON ST WA ZIP 980554561 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LICENSE# STATE WA SEX F M .C.B. 04 20 _ 1973 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
❑21❑ PLATE# CES1670 TATe 41
WA vIN# SYJYGDEE6MF210412 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE TESL MODEL MODEL Y STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO RAQUEL EDORA 2110 MONTEREY CT SE RENTON WA 98055 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAOE. IU
9TOP
'E""LE CITATION# CHARGE o BOTTOMLEGALYYES Nu25❑
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
M.LEVERTON 2517 [V7�ENCY
A0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED43179
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3098
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 03-16-23 09:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 311712023 10:00:39 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 7:51 AM TIME POLICE ARRIVED',7:55 AM
PART I PAGE IT]OF 4�
REPORT NO. ED43179 CASE# 23-3098 OF COLLISION
03/16/23 07:51
OF CbLLI510N
NARRATIVE
wht sedan In 2 eb stop slv suv/1 rear ph rang
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at about the 355 block
of S Grady Way.
I contacted the driver of unit 1 still blocking westbound lane 2.Unit 1 was ID'd by her picture WADL.
She told me she looked down and back up, not realizing traffic had stopped in front of her and rear-
ended unit 2. She did not complain of injury and damages did require a tow truck.
I contacted the driver of unit 2 who told me she was stopped for red light/traffic when she was hit from
behind by unit 1. She told me that unit 1 told her she was answering the phone. She did not complain
of injury and damages did not require a tow truck.
When I told unit 1 what unit 2 said, she told me that she did not answer the phone, that it rang and
she looked down at her phone then looked up when she hit unit 2.
1 cited unit 1 via complaint Ref RM 10-12-25 Driver Inattention 2 car crash.
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 3/16/2023
PAGE 3 OF 4
REPORT NO. ED43179 CASE# 23-3098 DATE AND TIME 03/16/23 07:51
OF COLLISION
nts
,y, t
PAGE 4 OF 4