HomeMy WebLinkAbout23-8335 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-8335 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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#
cowsloN 07 - 1-- 2023 1449 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
OAKESDALE AVE SW
e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SW 7TH ST
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 81
30
6� LAST NAME GANABAN FIRSTNAME EUSEBIO MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 24413 101 ST PL SE CITY KENT ST WA Zjp, 980305172 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEX'M MID
-O B 05 1— 27 — 1969 1 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� ABX0143 sTArI WAurN# 2CNALDEW5A6411138
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. A'RLR 1 5 33
12 0 0 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 9 34
13 2 2010 CHEV EQUINO DAMAGE vE8 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO EUSEBIO GANABAN.13101STPL SE KENTWA 98030 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI V INSURANCE INSURANCE CO MAIN STAMERICAO1J9799R
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLv Hlcle 1 5 36
YES�No D CITATION# 3A0329693 CHARGE INATTENTIVE DRIVING 1 o sorrow
STANDING 8 7 6
UNIT MOTOR Z PEDAL- ❑ PEDESTRIAN ❑ PROPERTY ❑ ET PHON DAM THR OLDME
1 VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME AL Y FIRST NAME GAMLAH MIDDLE N
INITIAL
17❑ STREET ❑', 2961 S HOLLY ST CITY' SEATTLE ST WA ZIP 981083735 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK v�Esl I I NOF YEs t l NO❑
19 LICENSE# STATE WA SEX F M D.C.B. 10 _ 31 1972 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE 448UKK TAre WA VIN# 2CNALDEW5A6411138
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE TOYT MODEL SIENNA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MARYJANEGANABAN,24413101STPL SE KENT WA 98030 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PEMCO CA 07233283IN 1'E""LE CITATION# CHARGE �,�
LEGALLY YES NEI
25❑ J Q.
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED85239
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8335
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
PM 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 07-20-23 03:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/1/2023 4:22:56 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 2:50 PM TIME POLICE ARRIVED',2:58 PM
PART I PAGE IT]OF 4�
REPORT NO. ED85239 CASE# 23-8335 OF COLLISION
07/20/23 14:49
OF CbLLI510N
NARRATIVE
sb In 1 gm van/2 red suv 1 rear on red
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Oakesdale Ave SW at SW 7th St.
I contacted the driver of unit 2 who told me she was hit from behind, but didnt really provide any
additional details. Partly because of a language barrier. She did not complain of injury and damages
did not require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he was south on Oakesdale in lane
one. Unit 2 was stopped in front of him and although he denied any other distractions crashed into
the back of unit 2. This portion of the roadway is flat and straight with no obstruction to have limited
unit 1 ability to see unit 2 stopped at the red light. He did not complain of injury and damages
required a tow truck.
I did observe the brake lights on unit 2 were functional.
I cited unit 1 ref RMC 10-12-25 Driver Inattention 2 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 7/20/2023
PAGE 3 OF 4
REPORT NO. ED85239 CASE# ' 23-8335 DATE AND TIME 07/20/23 14:49
OF COLLISION
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