HomeMy WebLinkAbout23-9981 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9981 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 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# ❑
cawsloN 08 - 1-- 2023 0716 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 1600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 750 00 FEET MILES e S B W e S PUGET DR
0 1 29
MOTUNIT O1 VEHICR PI PEDAL-CLE CYCLE ElYYESA�NO GE THRESHOLD MET PHONE 0 6 30
6� LAST NAME GURUNG FIRSTNAME KRISHNA MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 20258 142ND AVE SE CITY KENT ST WA 2jp, 980423008 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CCL9573 sTArI WAurN# 5YJ3E1EA9NF186152
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FR.. ro
TRLR. YRLR. 5 1 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2022 TESL MODEL DAMAGE vE6 0NO f �LII� RS vEs❑ No
REGISTERED OWNER INFO HERTZ VEHICLES LLC 18625 DES MOINES MEMORIAL DR SEATAC WA 98148 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP
VE— CHARGE to BOTTOM 5 36
LEGALLY YEs❑NO CITATION# 3A0329710,3A0329710 FOLLOW VEHICLE TOO CLOSELY,OP
15❑ STANDING 7 6
UNIT 02 MOTVEHICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERRTY ❑ DYES NO OLD MET PHONE
16 a
LAST NAME CROWLEY FIRST NAME SARAH MIDDLE I,I
INITIAL
17❑ STREET ❑', 14712 SE 172ND PL CITY' RENTON ST WA ZIP 980588701 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❑ 11
19 LICENSE# STATE WA SEX F M .C... 12 �_ 09 _ 1955 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BBZ5265 TAre WA vIN1t 2HKRM4H79GH662743
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2016 MAKE HOND MODEL CR-V STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SARAH CROWLEY 14712 SE 172ND PL RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 1 9TOP
VE""LE ❑ Nu,J CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.tEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97764
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9981
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ROBISON BRANDON L
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
9842 22ND AVE SW SEATTLE WA 981062622 SEX M MMDOYyry 11 - 19 - 1995
PASSENGER I�I WITNESS R UNIT# '; 1 SEAT IPOS. 9 AIRBAG 2 RESTR. 4 EJECT ? I HELMET INJURY ' NATURE of INJURIES
L�!1 USE .CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.Q.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 08-31-23 09:37 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 911112023 9:45:57 AM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED 7:16 AM TIME POLICE ARRIVED 7:16 AM
PART I PAGE IT]OF 4�
REPORT NO. ED97764 CASE# 23-9981 OF COLLISION
08/30/23 07:16
OF CbLLI510N
NARRATIVE
blk/1 rear slow maroon/2 lane 1
CC
Within the city limits of Renton/King/WA I onviewed a 2 car blocking crash near the 1600 block of
Talbot Rd S.
I contacted the driver of unit 2 who told me she was stopped northbound lane 1 for traffic when she
was hit from behind by unit 1. She did not complain of injury and damages did not require a tow
truck.
I contacted the driver of unit 1 ID'd by his matching picture WADL. He told me the brakes did not
work temporarily for his rental car and he ran into the back of unit 1. 1 checked the brake pedal as it
felt consistent with an operable brake system. Unit 1 was not able to provide valid proof of insurance
for his vehicle. He did not complain of injury and damages did require a tow truck. His passenger did
not complain of injury and wanted nothing to do with the crash, but walk away and get another Uber
to finish he ride to work.
I cited Unit 1 driver ref RCW 46.61.145 following too close two car crash and ref RCW 46.30.020 no
valid proof of insurance 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 8/31/2023
PAGE 3 OF 4
REPORT NO. ED97764 CASE# ' 23-9981 DATE AND TIME 08/30/23 07:16
OF COLLISION
nts
IIJF
nit 2
unit 1
PAGE 4 OF 4