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Home My WebLink About23-11369 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c COLLISION REP FIT 1591971 CASE 23-11369 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# cawsloN 10 - 1-- 2023 1447 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RAINIER AVE S BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e SWGRADYWAY 0 5 29 MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE 0 81 30 6� LAST NAME JONES FIRSTNAME ROBERT MIDDLE IN 1 2 31 INITIAL STREET ❑ 829E 9TH ST APT B CITY MEDFORD ST OR 21P 97442 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 :NTERLOCKYEs NO INTERLOCK YES NO YES No ❑ DRIVER'S' STATE OR SEX'M MM DI,Y' 05 — 09 — 1961 1 2 32 8 LICENSE# 9 ON DUTY❑ D. STATUS AIRBAG 1 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10[1P1 ATNES# YAJG121 sTAr OR v N 3AKJHHDROMSMH9506 -___� TRAILER HU63580 STATE OR TRAILER STATE 11 3 5 PLATE# PLATE# FROM ro TRLR TRLR 7 7 33 12 0 0 vIN#' 1L0106P200ZTSZQV VIN#' FROM TO VEH.YEAR I MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34 13 2 2021 FRHT CONVE DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO A&MTRANSPORTLLCPOBOX310 GLENDALEOR97442 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO SAME. 3 4 IN EFFECT &POLICY# 9TOP vEHla.e CHARGE 5 36 LEcntty Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254426223 16 a LAST NAME LE FIRST NAME THANH-THUY MIDDLE I T INITIAL 17❑ STREET ❑', 326 CEDAR AVE S APT 2 CITY RENTON ST WA ZIP 980576028 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 DRIVER'S STATE WA ]SEX IF D.Q.B. 03 _ 07 1966 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE ALM3248 TAre WA vIN# JTHBE262465007297 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2006 MAKE LEXS MODEL IS STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO GENE MEYER YES NO REGISTERED OWNER INFO THINHPHAM326CEDARAVESAPT2 RENTONWA98057 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&POLICY#E CO SAME.IN IUQ, 5vE""LE CITATION# CHARGELEGALYYES NEI25❑ J OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 M.LEVERTON 2517 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE06313 COLLISION REPORT III III III III III 111 1591972 CASE# 23-11369 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 10-04-23 03:59 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 101612023 6:54:05 AM BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 2:46 Pry TIME POLICE ARRIVED:2:52 PM PART I PAGE IT]OF REPORT NO. EE06313 CASE# 23-11369 OF COLLISION 10/04/23 14:47 OF CbLLI510N NARRATIVE red/wht semi u turn wht sedan eb to nb Itl RTF Within the city limits of Renton/King/WA I responded to a semi truck/trailer vs car blocking crash at the intersection of SW Grady Way at Rainier Ave S. I contacted the driver of unit 2 who told me she was stopped facing eastbound in the left turn lane to go north onto Rainier Ave S. While stopped at the red light, a large semi truck/trailer made a U-turn from EB SW Grady Way in the middle of the intersection and his trailer made contact with unit 2. She was unable to move her car from the roadway. Gene Meyer towed her car for damages. She did not complain of injury. I contacted the driver of unit 1 who told me he doesnt normally make he runs up in this area and was needing to get turned around. He said he attempted a U-turn in the intersection when his trailer caught unit 1 near the driver front headlight. There was no remarkable damage to unit 1 or his trailer 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 10/3/2023 PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EE06313 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 23-11369 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT# 1 USDOT 0344894 ICC# VEHICLE TYPE 4 CARGO BODY 2 TYPE 2 ❑ 1 28 CARRIER NAME A&M TRANSPORT ....... 3 CARRIER ADDRESS PO BOX 310 CITY GLENDALE ST OR ZIP 97442 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 2 AXLES 05 GI 80000 + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnnRFrtP. CITY ST ZIP 6 � CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES❑N0� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NFln+AnnRFs.� CITY'. ST SIP CDL IGNITION REDUIRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYSYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. X LEVERTON 10-04-23 03:59 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OI BADGE 2517 O#I,WA0171300 JOHNSON 10/6/2023 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EE06313 CASE# ' 23-11369 DATE AND TIME 10/04/23 14:47 OF COLLISION i 3, PAGE 5 OF 5