HomeMy WebLinkAbout23-14651 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-14651 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 5 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 12 - 1-- 2023 1110 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
MAIN AVE S MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S 3RD ST
0 1 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE 0 11
30
6� LAST NAME TRAN FIRSTNAME VIET MIDDLE V 1 1 2 31
INITIAL
STREET ❑, 1065 FOUNTAIN HEAD LN CITy LAWRENCEVILLE ST GA 2jp, 300437538 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 HELM
USEET I IINLJA
URY 1 [!!RE OF INJURIES 2❑
3
10 1❑ PI ATE 14 BMX8387 STATE WA VIN# 2T3ZF4DV36W082789
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 3 34
2011 TOYT RAV4 DAMAGE YES NO YES[:] No✓
13 1
REGISTEREDOWNERINFO TA1-125631144THAVESE KENTWA98042 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE U INSURANCE CO GEICO 4454.24.99.31 3 4
IN EFFECT &POLICY# 9TOP
LEwoL I CHARGE 1 5 36
LE-Lv YEs No clTAnoN# 3A0681752 IMPROPER LANE USAGE o eorrom
15❑ STANDING 8 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069408587
16 a
LAST NAME BROWN FIRST NAME GLEN MIDDLE I B
INITIAL
17❑ STREET ❑', 1319 N 28TH ST CITY' RENTON ST WA ZIP 980562164 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 LDIIVERS STATE WA SEX M M .C.B. 09 _ 28 _ 1971 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I WY-384-818 TATe I WY VIN1i JTMA83FVOPD153452
❑ 41
PLATE#
42
22❑ PLATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE TOYT MODEL RAV4 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO COHESION SIGNING SERVICE 1319 N 28TH ST RENTON WA 980562164 D:2069408587 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 01969481-7IN 1GQ'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. EE34926
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14651
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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 12-27-23 07:44 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 12/28/2023 7:08:20 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED' 11:10 AM TIME POLICE ARRIVED',11:10 AM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE34926 CASE# 23-14651 OF COLLISION12/21/23 11:10
NARRATIVE
wht suv/2 lane 2 rt wht suv lane 1 straight
CC
Within the city limits of Renton/King/WA I on-viewed a 2 car blocking crash at the intersection of Main
Ave S at S 3rd St.
I had both cars move to a nearby parking lot.
I contacted the driver of unit 1 who told me he was in lane 2 northbound which is a through/right turn
lane with the intention of turning right. He told me unit 1 was in lane 1 which is a right turn lane only.
Unit 2 told me that as he was making his lawful right turn unit 1 contacted the side of his car in his
lane. He did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his Georgia DL. He did not provide any additional information
from a language barrier. Although he was on a cell phone with his son, he did not provide much
information ref the crash. Unit 1 driver via his son did not complain of injury and damages did not
require a tow truck.
I cited unit 1 ref RCW 46.61.140 Improper lane use, 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 12/27/2023
PAGE 3 OF 4
REPORT NO. EE34926 CASE# ' 23-14651 DATE AND TIME 12/21/23 11:10
OF COLLISION
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