HomeMy WebLinkAbout23-9479 ITFF' "POLCERA II I !�� I III I III I IIII III II I . B 27c
COLLISION REP FIT 1591971
CASE 23-9479 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 08 - 18 - 2023 1047 17 ❑-= S 8 E IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
L1ND AVE SW MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW 34TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252419519 0 11
30
6� LAST NAME HOWARD FIRSTNAME JASON MIDDLE E 1 2 31
INITIAL
STREET ❑ 1826 187TH STREET CT E CITY SPANAWAY ST WA 2jp, 983874141 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEX'M MM DAY' 02 1- 13 - 1990 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 C52643M STATE WA VIN# ZFBERFBB6J6J59975
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 1 $ 34
13 2018 RAM PROMA DAMAGE YES ✓ NO � '` RS YES❑ No✓
REGISTERED OWNER INFO SIEMENS INDUSTRYINC 666 GARLAND PL DES PLAINES IL 60016 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO SAME SAME 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLYYES❑NO❑ CITATION# 3A0329704 FAIL STOP AT STOP <1�3
orrom
15❑ STAIN.D'ING 7 6
UNIT VE IOOR CYCLE ❑PEDAL- PEDESTRIAN ❑ OWNERRTY ❑ DYES✓ NO OLD MET PHONE
16 a •,
LAST NAME MERIALES FIRST NAME ARRON MIDDLE I C
INITIAL
17❑ STREET ❑', 24807 115TH AVE SE CITY KENT ST WA ZIP 980306584 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 12 _ 18 _ 2000 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CAS0051 TATE WA VIN# 5YFS4MCE4NP099852
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2022 MAKE TOYT MODEL COROLL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO ARNULFO MERIALES 582 OCEAN SHORES BLVD SW OCEAN SHORES WA 98569 VEHICLE NO.2
SHADE IN DA GEbAREA
z Cdd
LIABILITY
INSURANCE INSU&POLICY#E CO SAME SAMEIN 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. ED90528
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9479
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 08-18-23 11:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 811812023 1:25:39 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 10:47 AM TIME POLICE ARRIVED 11:00 AM
PART I PAGE IT]OF 4�
REPORT NO. ED90528 CASE# 23-9479 OF COLLISION
08/18/23 10:47
OF CbLLI510N
NARRATIVE
wht van/unit 1 ran stop sign lane 2 gray unit 2 sb lane 2
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Lind Ave SW and SW 34th St.
I contacted the driver of unit 2 seated on the sidewalk. Before unit 2 driver could answer any
questions unit 1 blurted out he caused the crash by running the stop sign and crashing into the side of
unit 2. Unit 2 agrees and explained he was southbound in lane 2 when unit 1 ran into the side of him.
He did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. He reiterated he was distracted by watching
another vehicle and was thinking about parts he was needing to get to Olympia when he ran passed
the proper posted stop sign. He did not complain of injury and damages required a tow truck.
I cited unit 1 Ref RCW 46.61.190.2 FCTW stop sign, two 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 8/18/2023
PAGE 3 OF 4
REPORT NO. ED90528 CASE# ' 230479 DATE AND TIME 08/18/23 10:47
OF COLLISION
N nts
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PAGE 4 OF 4