HomeMy WebLinkAbout23-14536 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE33299 170
27
COLLISION REP FIT 1591971
CASE 23-14536 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
cawsloN 12 - 19 - 2023 0707 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
TALBOT RD S MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W HF j GgApyWAy
0 4 29
UNIT MOTOR
� PEDAL-
❑ YESAGE NHORE✓LD MET PHONE 0 4 30
6 LAST NAME RAMIREZ VIDAL FIRST NAME JORGE MIDDLE C 1 2 31
INITIAL
STREET ❑ 19001 SE WAX RD UNIT A CITY COVINGTON ST WA ZIP, 980424879 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 USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
LICENSE C97285N sTAr WAuN# 1G63GSCG7H1131690
10 1❑ PI ATE�
----� TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 7 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 ] 34
13 2 2017 CHEV EXPRES DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO WESTERN INSULATION SERVICEINC 17969 WSPRING LAKEDR SE RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO eq�T3 4
IN EFFECT &POLICY# 9TOP
VEHICE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY THR OLD MET PHONE
T VEHICLE ❑ CYCLE ❑ ❑ OWNER [:][LAM ES 1/ NO PHONE
2063105007
16 a
LAST NAME MCNEILLY FIRST NAME CAROL MIDDLE A
INITIAL
17❑ STREET ❑', 11403 SE 186TH ST CITY' RENTON ST WA ZIP 980557152 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 LDIIVEW # STATE WA ]SEX IF MMDDW 05 _ 18 _ 1972 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CGB5092 TAre WA VIN# 5NMJBCAE9PH198839
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE HYUN MODEL TUCSON STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CAROL MCNEILLY 11403 SE 186TH ST RENTON WA 980557152 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO PEMCO CA 1605613IN I STOP 5
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES s 6
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. EE33299
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14536
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 12-19-23 11:33 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 12/22/2023 8:11:34 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 7:08 AM TIME POLICE ARRIVED',7:08 AM
PART I PAGE IT]OF 4�
REPORT NO. EE33299 CASE# 23-14536 OF COLLISION
12/19/23 07:07
OF CbLLI510N
NARRATIVE
gry2 It osl wht box insise went wide
RTF
Within the city limits of Renton/King/Wa I responded to a collision that had just happened at the
intersection of Talbot Rd S at S Grady Way. I was across the street when the crash took place. I did
not see or hear it.
I contacted the driver of unit 2 who told me that had already exchanged information, but I was so
quick to arrive she asked for a police report. She told me she was NB on Talbot and making a left
turn to WB Grady. She said she was in the outside left turn lane while unit 1 was turning from the
inside left turn lane. She explained that during the turn unit 1 crossed over into her lane and
contacted the rear driver side of her vehicle. She did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit one. He did not provide any statement or version of the crash (Language
barrier). He was unable to locate his company vehicle insurance card. Damages were unremarkable
and he did not complain of injury.
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 12/19/2023
PAGE 3 OF 4
REPORT NO. EE33299 CASE# 23-14536 DATE AND TIME 12/19/23 07:07
OF COLLISION
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