HomeMy WebLinkAbout23-14574 ITFF' "POLCERA II I !�� I III I III I IIII III II I . B 27c
COLLISION REP FIT 1591971
CASE 23-14574 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 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#
COLLISION.. 12 - 1-— 2023 0727 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
HARDIE AVE SW
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SW 7TH ST
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/ENHORESHOLDMET PHONE 0 4 30
6� LAST NAME GIDDENS FIRSTNAME CASANDRA MIDDLE M 1 2 31
INITIAL
STREET ❑ 12102 SE 174TH LN APT JJ101 CITY RENTON ST WA 2jp, 980586246 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEX'F M .DAY' 04 1— 17 — 1992 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CHE3852 sTArI WAurN# 1G1PC5SH1G7201034
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34
13 r 2016 CHEV CRUZE DAMAGE YES NO ✓ YES[:] No
✓
REGISTERED OWNER INFO CASANDRA GIDDENS 12102 SE 174TH LNAPTJJ101 RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO E-SURANCEPAWA-009378056 3 4
IN EFFECT &POLICY# 9TOP
ve'CLe CHARGE 1 5 36
LEGALLY YEs No clTAnoN# 3A0681751 FAIL TO OBEY TRAFFIC CONTROL o aorrom
15❑ STANDING 8 6
UNIT U2 VEHIMOTCLE z CYCLE ❑ PEDESTRIAN ❑ OWN ARTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME BUI FIRST NAME HIEN MIDDLE 1 M
INITIAL
17❑ STREET ❑', 259 CAMAS AVE SE CITY' RENTON ST WA ZIP 980568857 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.Q.B. 10 _ 19 _ 1973 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE D8278C TAre WA VINIi 1HA6GU871PN005353
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE UNKN MODEL DUNE STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
L4❑ DAMAGE YESfj
NO✓ YES NO✓
REGISTERED OWNER INFO RENTON SCHOOL DISTRICT 420 PARK AVE N RENTON WA 98057 D:4252044455 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IGQVE""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. EE33300
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14574
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JOHNSON GIDEON
(LAST FIRST,
ADDRESS&PHONE#
600 SW 5TH CT#E206 RENTON WA 98055 2066363634 SEX M MMDOYyry 10 - 29 - 2010
PASSENGER L,WITNESS UNIT# j 2 POS 9 AIRBAG 2 RESTR. 4 EJECT ? 1 HEL EET CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS&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 12-20-23 08:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 12/22/2023 8:12:50 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 7:27 AM TIME POLICE ARRIVED',7:Y8 AM
PART I PAGE IT]OF 4�
REPORT NO. EE33300 CASE# 23-14574 OF COLLISION
12/20/23 07:27
OF CbLLI510N
NARRATIVE
dk blu sedan/1 lane 1 eb ran red bus left tun hardie to 7th
CC
Within the city limits of Renton/King/Wa I responded to a blocking crash at the intersection of Hardie
ave SW at SW 7th St. It was initially reported as a blocking injury school bus crash.
I contacted the driver of unit 2 who told me he was making a left turn on his green light when unit 1 hit
his bus. The one passenger on board said they were completely fine with no injury. Unit 2 driver did
not complain of injury and damages did not require a tow truck.
The driver of unit 1 ID'd by her picture WADL said she was eastbound lane 1 and ran a red light and
hit unit 2. She did not complain of injury and damages did not require a tow truck.
I cited unit 1 driver ref RCW 46.61.055 FTCWTCD-Red Light 2 vehicle 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 12/20/2023
PAGE 3 OF 4
REPORT NO. EE33300 CASE# 23-14574 DATE AND TIME 12/20/23 07:27
OF COLLISION
nts
PAGE 4 OF 4