HomeMy WebLinkAbout23-7663 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7663 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 07 - 1-- 2023 1522 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
S 7TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ �,❑ FEET e S ❑ VV a SMITHERS AVE S
0 1 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE 0 11
30
6� LAST NAME THOMAS FIRSTNAME GERMAINE MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 240 GARDEN AVE N CITy RENTON ST WA Zjp, 980575731 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H U SE CLASS 7 SORE NECK INJDRIES z❑
3
10 9❑ P1 ATE 14 CAL8513 STATE WA - 1G1PF5SC9C739715
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34
13 2 2012 CHEV CRUZE DAMAGE vE5 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO RAYA SCOT123938109THAVESE#2C204 KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 5 36
LEGALLY YES No CITATION# 3A0329686,3A0329686 FAIL STOP AT STOP o sorroM
15❑ STANDING 8 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT a2 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES 1/ NO
VEHICLE CYCLE OWNER
16 a
LAST NAME FORTNER FIRST NAME PHILLIP MIDDLE A
INITIAL
17❑ STREET ❑', 5908 LEAWOOD RUN CT CITY' CHARLOTTE ST' NC ZIP 282696195 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs I I NOF YEs t l NO❑
19 DCENSE# STATE NC SEX M M D.C.B. 08 _ 10 _ 1990 39
HELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CBE1737 TATe WA VIN1t WINOG8EB5LF794363
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2020 MAKE MERZ MODEL GLC STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MERCEDES-BENZOFSEATTLE2025AfRPORTWAYS SEATTLEWA98134 VEHICLE NO.2
SHADEDAMAGED AREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
VE""LE ❑ Nu,J CITATION# CHARGE to 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
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED78176
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7663
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 07-05-23 04:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 711012023 11:17:22 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 3:22 Pry TIME POLICE ARRIVED',3:24 PM
PART I PAGE IT]OF 4�
REPORT NO. ED78176 CASE# 23-7663 OF COLLISION
07/05/23 15:22
OF CbLLI510N
NARRATIVE
blu/1 eb wht nb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of S
7th St at Smithers Ave S.
I contacted the driver of unit 2 who told me he was northbound on Smithers and headed straight
through the intersection when unit 1 pulled across his path where they collided. Unit 2 did not
complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was east bound at the
intersection. He told me it was "His Turn" and he proceeded when he was hit by unit 2. He told me
there were no cars when he was proceeding. He was checked by Renton Fire for a sore neck.
Damages did require a tow truck. He was not able to provide valid proof of insurance. Unit 1 kept
telling me it was his turn to go and that it was clear.
There was a close by neighbor who yelled over the railing of her apt and told unit 1 he did not have
the right of way. She did not want to be ID'd or involved any further.
I tried to explain to unit 1 driver that he is required to stop and remain until it is clear of hazard as
traffic from the south to the north is not controlled by a stop sign and are not required to stop.
I cited unit 1 via complaint ref RCW 46.61.190.2 FTYROW and RCW 46.30.020 No Insurance..
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 7/5/2023
PAGE 3 OF 4
REPORT NO. ED78176 CASE# ' 23-7663 DATE AND TIME 07/05/23 15:22
OF COLLISION
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