HomeMy WebLinkAbout23-14358 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-14358 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I 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# ❑
cowsloN 12 - 1-- 2023 1429 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BL N BLOCK NO. e✓ 223
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1501. 00 FEET MILES e S B W e N 3RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4259817917 0 7 30
6 LAST NAME SANCHEZ ROMERO FIRST NAME ANGELA MIDDLE M 1 2 31
INITIAL
STREET El 26225 108TH AVE SE CITY KENT ST I WA 2jp, 980307733 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 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATFBit CHN5785 sTArI WA urN#' 1 HGFA16887L 121492
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 9 34
13 2 2007 HOND CIVIC DAMAGE vE5 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO FELIXMARQUEZROMERO 21225108THAVE SE KENT WA 98030 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4
14 LIABILITY INSURANCE❑ INSURANCE CO 3
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
LEGALLY Yes❑NO❑ CITATION# CHARGE
1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�IJNITU2 VEHICLE ❑ CYCLE ❑ ❑ PROPOWNER ❑ YES1/ No D:2538783969
16 a
LAST NAME WILLIAMS FIRST NAME JAMES MIDDLE I C
INITIAL
17❑ STREET ❑', 3910 E R ST CITY TACOMA ST WA ZIP 984044668 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALt-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NoF YES t l NO❑
19 DRIVER #
I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE BNT4855 TAre WA VIN1t 1FMCUOF76GUC60679
❑ 41
PLATE#
42
22❑ PLATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2016 MAKE FORD MODEL ESCAPE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JAMES WILLIAMS 3910ERST TACOMA WA 984044668 D:2538783969 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU POLICY#E CO GEICO 2019-13-09-01IN I 9TOP
VEwcLE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES N�
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE33298
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14358
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 12-14-23 03:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 12/22/2023 8:09:40 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED'I 2:29 Pry] TIME POLICE ARRIVED',2:36 PM
PART I PAGE IT]OF 4�
REPORT NO. EE33298 CASE# 23-14358 OF COLLISION
12/14/23 14:29
OF CbLLI510N
NARRATIVE
blu suv 2 lane 2 stop blue sedan 1 rear
RTF
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash near the 200 block of
Sunset Blvd N. While enroute both vehicles were able to clear the roadway.
I contacted the driver of unit 2 who told me he was stopped southbound in lane 2 Sunset Blvd N for
heavy traffic when he was hit from behind by unit 1. He did not complain of injury and damamges did
not require a tow truck.
I contacted the driver of unit 1 who said she saw a green light but didnt realize traffic was stopped in
front of her. Although she slammed on the brakes it was not in time to avoid contact with unit 2. She
did not complain of injury and damages required a tow truck.
Information/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 12/14/2023
PAGE 3 OF 4
REPORT NO. EE33298 CASE# ' 23-14358 DATE AND TIME 12/14/23 14:29
OF COLLISION
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