HomeMy WebLinkAbout23-8518 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-8518 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� TOTAL#OF OBJECT 1 �2$
TRIBAL UNITS 01 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 1413 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY BLOCK NO. e✓ 15400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 600 00 FEET MILES e S B W e SE 154TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2063534888 30
6� LAST NAME WHITE-WELLS FIRSTNAME HEIDI MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 19231 SE 263RD ST CITY COVINGTON ST WA ZIP 980426020 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10❑ P1 ATNES# C72131 P sTAr WAV N# 5TEMU52N65Z140492
TRAILER STATE TRAILED STATE
11 4 0 PLATE# PLATE# FRom To
TRLR. TRLR. S 1
2❑ 33
1 VIN#' VIN#'
Rom 34
13� VEH.YEAR 2OOS MAKE TOYT MODEL TACO STYLE IV
AMAGE TOWED NOO pLSABLIN TQ yED.BLRS VEHICLE
DAMAGE IILLJJII ttSSAA1IVV/i��66
REGISTERED OWNER INFO HE IV11TE 19231 SE 263RD ST COVINGTONWA 98042 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO USAA 00366 76 86C 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ PHONE
STANDING 7 6
UNIT 02 MOTOR
❑ CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES NO OLD METVEHIC
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s � e
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. ED85544
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8518
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) JOE
ADDRESS&PHONE# D.O.B.
2065951095 SEX' U MMDDYYYY -❑
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET CLASS U NATURE OF INJURIES
❑✓ SOS. USE I
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# E4
SEX .Do.MDYYYV
PASSENGER ❑WITNESS❑ UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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 07-26-23 10:14 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/2/2023 12:50:39 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 2:13 PM TIME POLICE ARRIVED]2:21 PM
PART I PAGE IT]OF 4]
REPORT NO. ED85544 CASE# 23-8518 OF COLLISION
07/25/23 14:13
OF CbLLI510N
NARRATIVE
nb lane 1 deer
RTF
Within the city limits of Renton/King/WA I responded to a car vs deer blocking crash near the 15400
block of 140th Way
I contacted the driver of unit 1 who told me that she was northbound lane 1 when a deer ran in front of
her truck without time to avoid contact. She did not complain of injury and damages to her truck did
require a tow truck.
A Witness/Joe said he watched as the deer ran across the street into the path of unit 1.
There deer was DOA.
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 7/25/2023
PAGE 3 OF 4
REPORT NO. ED85544 CASE# ' 23-8518 DATE AND TIME 07/25/23 14:13
OF COLLISION
UNIT 1 POR
nts
NIT 1 P01
PAGE 4 OF 4