HomeMy WebLinkAbout23-11182 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE05509 170
27
COLLISION REP FIT 1591971
CASE 23-11182 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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# ❑
cowsloN 09 - 1-- 2023 1056 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S CARR RD BLOCK NO. e✓ 10700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e 106TH PL SE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2534363004 0 11
30
6� LAST NAME WILSON FIRSTNAME STACEY MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 2020 GRANT AVE S APT C201 CITY RENTON ST WA ZIP' 980553642 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]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❑ P1 aT�S� CFH8487 sTArI WAurN# KNDPM3AC4J7320413
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TPILF1 1 3 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 ] 34
13 2018 KIA SPORTA DAMAGE YES NO MEYER YES[:] NO✓
REGISTERED OWNER INFO STACEY WILSON 2120 GRANT AVE S APT C201 RENTONWA980553642 D:2534363004 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO SAFECO H2255573
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3A0681699 FAIL YIELD PRIVATE RD MOTOR 1 o aorrom
15❑ STANDING 8 7
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES NO D:2063275321
VEHICLE CYCLE OWNER
16 a
LAST NAME MORENO FIRST NAME RICHARD MIDDLE I L
INITIAL
17❑ STREET ❑', 11924 SE 169TH PL CITY' RENTON ST WA ZIP 980586002 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 LDI IVEW # STATE WA SEX M M MD D.C.B.B. 01 22 _ 1964 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BEC5921 TAre WA VIN# 1HGCR2F53EA087655
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2014 MAKE HOND MODEL ACCORD STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO RICHARD MORENO 11924 SE 169TH PL RENTON WA 980586002 D:2063275321 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO ST FARM 146 8825 EO147FIN STOP 5
'EwCLE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N`L J
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE05509
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11182
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'
gold suv/1 It cvs blk sedan/2 lane 2 wb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking at about the 10700 block of S
Carr Rd.
I contacted the driver of unit 2 who told me he was westbound in lane 2 when unit 1 pulled from the
CVS driveway turning left, but his his car along the way. He did not complain of injury and damages
required a tow truck.
I contacted the driver of unit 1 ID'd by her picture WADL as Stacey Wilson. She told me she was
turning left from CVS and crashed into the side of unit 2. She did not complain of injury and damages
required a tow truck.
I cited unit 1 ref RCW 46.61.205 FTYROW from a private drive onto the roadway 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 9/29/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 09-29-23 03:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOSS 1953 101312023 2:27:38 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 10:56 AM TIME POLICE ARRIVED';11:02 AM
PART I PAGE IT]OF 3�
REPORT NO. EE05509 CASE# ' 23-11182 DATE AND TIME 09/29/23 10:56
OF COLLISION
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unit 1
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