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Home My WebLink About23-4106 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-4106 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 04 - 1-- 2023 0701 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 3RD ST BLOCK NO. e✓ 1800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 350 00 FMILES EET e S ❑ W e MONTEREYDR NE 2 0 29 UNIT 01 VEHtOCLE PEDDAL ❑ YESAGE NHORE✓LDMET PHONE Q 1 30 6� LAST NAME NAVARRETE FIRSTNAME JORGE MIDDLE A 1 2 31 INITIAL STREET ❑ 18521 225TH AVE E CITY ORTING ST WA ZIP 983609643 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LRIIVER # STATE WA SEX'M MI D Y' 08 - 03 - 1967 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM USEET ICNLJAURY 1 NATURE OF INJURIES 2❑ 3 10 9� P1 AT 14 C5557C STATE WA VIN# 1XPCP4EX7KD626418 ----� TRAILER D0949C STATE WA TRAILER STATE 11 3 5 PLATE# PLATE# FROM ro TRLR TRLR 7 3 33 12 3 5 vIN# 1W91S5034NM288050 VIN#' FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 3 2019 PTRB 567 DAMAGE YES YES : NO✓ REGISTERED OWNER INFO KING COUNTYSOL/D WASTE DIVIS 201 S JACKSON ST STE 701 SEATTLE WA 98104 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO SAME. 3 4 IN EFFECT &POLICY# 9TOP 15❑ vewcLE 5 36 LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE �NiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:3604393621 16 a LAST NAME GRIFFIN FIRST NAME DONNA MIDDLE I L INITIAL 17❑ STREET ❑', 5221 S 297TH PL CITY'AUBURN ST WA ZIP 980012347 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOF INTERLOCK YEs It I NOF YES t t— l NO❑ 19 F] LDI IVEW # STATE WA ]SEX IF M D.C.B. 10 _ 04 1973 El 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 1 USE CLASS ❑ 21❑ LICENSE I DP69111 TATe WA vIN# 2C4RDGDGXDR719652 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. IN#. 43 RLR ' VEH YEAR 2013 MAKE DODG MODEL GRAND STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO ALBERTO EUFRASI05221 S 297TH PL AUBURN WA 98001 VEHICLE NO.2 SHADE IN DA GEbAREA z Cdd INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IGQ'E""LE ❑ ,J� CITATION# CHARGE 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. ED50933 COLLISION REPORT III III III III III 111 1591972 CASE# 23-4106 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 04-12-23 07:41 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 411312023 11:45:44 AM BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 7:02 AM TIME POLICE ARRIVED',7:05 AM PART I PAGE IT]OF REPORT NO. ED50933 CASE# 23-4106 OF COLLISION 04/12/23 07:01 OF CbLLI510N NARRATIVE slv unit 2 gray semi unit 1 RTF Within the city limits of Renton/King/WA I responded to a semi vs car near the 1800 block of NE 3rd St. I contacted the driver of unit 1 who told me he was making a right merge and it was completely clear as he was changing lanes. He told me in the initial part of his lane change unit 2 proceeded passed his location and the two vehicles has slight contact. He told me it appeared unit 1 was going too fast. Unit 1 did not complain of injury and damages did not require a tow truck. I contacted the driver of unit 2 who told me she was driving passed the "weird" spot of the road and was trying to get over into lane 2 away from unit 1 but did not get over while contact was being made between the vehicles. She did not complain of injury and damages did not require a tow truck. There were no witnesses to corroborate the collision or a debris field to describe POR etc. Damages on both vehicles were minor. 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 4/12/2023 PAGE 3 OF 5 SUPPLEMENTAL REPORT No. ED50933 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-4106 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓ G UNIT# 1 USDOT ICC# I VEHICLE TYPE 6 CARGO BODY 12 TYPE 2 ❑ CARRIER 1 28 KING COUNTY SOLID WASTE NAME 3 CARRIER ADDRESS 201 S JACKSON SR 701 CITY SEATTLE ST WA ZIP'', 98104 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 3 AXLES 07 GI 98000 + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnnRFSP CITY ST ZIP 6 2 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES E]NO� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIC P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NFln+AnntxFs.� CITY'. ST SIP CDL IGNITION REQUIRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs N. El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN 39 LICENSE # PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. K LEVERTON 04-12-23 07:41 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OR ID 2517 O#IL..WA0171300 JOHNSON 411312023 PAGE�OF F 3000-345-013(R 11118) REPORT NO. ED50933 CASE# 23-4106 DATE AND TIME 04/12/23 07:01 OF COLLISION N nts PAGE 5 OF 5