HomeMy WebLinkAbout23-14778 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-14778 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' TREE OR STUMP
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 1711 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 3RD ST BLOCK NO. e✓ 2100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FMILES EET e S ❑ W e BLAINEAVENE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2065787191 0 11
30
6� LAST NAME ROBINSON FIRSTNAME SHAWNTAE MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 2116 S 272ND ST APT A301 CITY KENT ST WA ZIP 980326971 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED1/ I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO NTERLOCKYEs NO Z/ _YES R NoF,/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI aT�S1t BV61529 sTArI WAvIN#' WDBUF56X286194157
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE ] $ 34
13 2008 MERZ VST SD DAMAGE YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO JORDAN LAIRD 2307 NE4TH STAPTL307 RENTON WA 980568830 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP
VEF" CHARGE BOTTOM 5 36
EGALLY YES No CITATION# 3A0852521,3AO852522 DWLS 3RD DEGREE,OP MOT VEH
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN : PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067422439
16 a
LAST NAME ELMORE FIRST NAME TERRANCE MIDDLE E
INITIAL
17 STREET I❑ S❑' 6921 S 123RD ST APT B133 CITY' SEATTLE ST WA ZIP 981784159 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 F] DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CES3772 TArE 41
WA VIN# 3GSDA03L37S560660 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2007 MAKE BUIC MODEL RENDEV STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO TERRANCE ELMORE 6921 S 123RD ST APT B133 SEATTLE WA 981784159 D:2067422439 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO PROGRESSIVE 975340364IN STOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 a
7KEV
S NAME(PRINT) OFFICER PHONE BADGE OR ID# [ZoNCY
26
PETERSON 12808 171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE39309
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14778
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WILTURNER JASMINE M
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B.
2307 NE 4TH ST APT L 307 RENTON WA 98056 2064250786 SEXi F MMDOYyry 02 - 15 -SEAT 2000
PASSENGER Z WITNESS UNIT# 1 POS USE 2 CLASS
3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET L NATURE OF INJURIES
11
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.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.
KEVIN PETERSON 12-26-23 06:44 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 111112024 6:06:09 AM
BADGE OR ID# 12808 OR]# WA0171300 TIME POLICE DISPATCHED 5:13 PM TIME POLICE ARRIVED 5:16 PM
PART I PAGE IT]OF 4]
REPORT NO. EE39309 CASE# 23-14778 OF COLLISION
12/25/23 17:11
OF CbLLI510N
NARRATIVE
I was dispatched to the collision on 12/25/23 at 1713 hours at NE 3rd St in the 2100 block in city
Renton, King county WA.
Unit 1 BUB2178 Driver Robinson, Shawntae N (08/15/1977)
Unit 2 CES3772 Driver Elmore, Terrance E (05/13/1981)
Both drivers were identified by their WADL.
Unit 1 was traveling East on Ne 3rd St in the lane 2 when she stated she was unsure what happen
and ended up on the side of the road. The passenger stated that they were traveling East on NE 3rd
St when Unit 2 drove into their lane. Unit 1 then swerved into oncoming traffic and then turn back into
their lane and ended up on the side of the road. Unit 2 stated he was traveling East on NE 3rd St
when he said all he knew was he ended up on the side of the road into a tree. Unit 2 stated he thinks
he was hit but could not state where are how he was hit and did not see anything.
I did not find any damage to either vehicle consistent with a collision to another vehicle.
Both drivers stated they had no injuries on scene.
Upon request Robinson, Shawntae N (08/15/1977) was unable to provide proof of insurance.
I identified the driver via a valid WAID as Robinson, Shawntae N (08/15/1977). The defendant was
operating a motor vehicle in the City of Renton, Washington. Upon checking DOL, DOL showed the
defendant to have a driver's license that was suspended or revoked in the third degree.
Defendant was driving while license suspended or revoked as listed above by operating a motor
vehicle in the State of Washington while DOL showed status DWLS.
Shawntae was cited for DWLS 3rd degree and no insurance.
PAGE 3 OF 4
REPORT NO. EE39309 CASE# ' 23-14778 DATE AND TIME 12/25/23 17:11
OF COLLISION
Unit 1'
Tree
Unit 2
1 .
PAGE 4 OF 4