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Home My WebLink About23-11514 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 23-11514 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cowsloN 10 - 1-- 2023 1650 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE PETROVITSKY RD BLOCK NO. e✓ 11800 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e 118THAVE SE 0 4 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2067184737 0 4 30 6� LAST NAME MONTGOMERY FIRSTNAME ELIJAH MIDDLE F 1 1 2 31 INITIAL STREET ❑, 12725 SE 167TH ST CITY RENTON ST WA Zlp' 98058 z= NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8 LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 aTES� C14075X sTArI WAvIN# 1FTPX14596FA03698 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR. 3 5 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR 2006 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 5 34 13 FORD F150 PK DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO JAMES MONTGOMERY 11119 SE 229TH PL KENT WA 98031 D:2068515755 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 ❑ INSURANCE CO 3 4 LIABILITY INSURANCE IN EFFECT &POLICY# � 9TOP 5 vewcLE CHARGE 10 BOTTOM 36 EGHALLY YES❑NO CITATION# 3A0722961,3A0722961, NO VALID OPER LICENSE WITH 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT a2 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2068515755 16 a LAST NAME MONTGOMERY FIRST NAME JAMES MIDDLE E INITIAL 17 STREET❑ NEW ADDRESS❑' 11719 SE 229TH PL CITY KENT ST WA ZIP 98031 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL—T�RANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NoF,/ 19 LICENSE# STATE I INA SEX M M D.C.B. 08 �_ 12 _ 1999 � 39 20❑ ON DUTY STATUS AIRBAG, 1 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE of INJURIES ❑ 40 USE CLASS BLEEDING LOWER LIP ❑21❑ PLATE# AXZ2258 TArE 41 WA VIN# JN1HS36PXKW035537 1 42 22❑ PLATE# STATE pLATE ILER# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 1989 MAKE NISS MODEL 240SX STYLE CP VEHICLETOWED TO BLIN TOWEDBY GOV HI �44 24❑ DAMAGE YES NO GENE MEYER YES NO REGISTERED OWNER INFO SUSAN KRANZLER 12725 SE 167TH ST RENTON WA 98058 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5 LE L..LLY YES❑ N J CE] CITATION# CHARGE io BOTTOM LEGA 25 BADJ e OFFICER'S NAME(PRINT) OFFICER PHONE GE OR ID# AGENCY 26 BENJAMIN FLICK 12825 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE07090 COLLISION REPORT III III III III III 111 1591972 CASE# 23-11514 ADDITIONAL PERSONS INVOLVED PASSENGERS ANWOR 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. BENJAMIN FLICK 10-07-23 06:41 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 101812023 5:19:08 PM BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED 4:51 PM TIME POLICE ARRIVED',4:52 PM PART Ei PAGE IT]OF REPORT NO. EE07090 CASE# 23-11514 OF COLLISION 10/07/23 16:50 OF CbLLI510N NARRATIVE 23-11514 On 10-07-2023 at approximately 1651 hours I was working a marked Renton Police Department patrol in full uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision at the cross of SE Petrovitsky RD and 118th AVE SE. Upon arrival I made contact with all 3 vehicles and drivers involved. All involved drivers agreed upon the circumstances that occurred. The involved units and drivers were identified as follows: Unit 01 (WA/C14075X) driver Elijah F. Montgomery (DOB: 08-02-2001 via WADOL) Unit 02 (WA/AXZ2258) driver James E. Montgomery (DOB: 08-12-1999 via WADOL) Unit 03 (WA/BSE7205) Gregory D. Fisher (DOB: 01-26-1963 via WADOL) Unit 01 was towing unit 02 with a soft tow-strap. James E. Montgomery was steering unit 02 and applying brakes when needed. Unit 01 was facing westbound on SE Petrovitsky RD and turned southbound onto 118th AVE SE. Unit 01, while towing unit 02, failed to yield right of way to unit 03 which was proceeding eastbound on SE Petrovitsky RD. Unit 03 was not able to stop in time and collided with unit 02. Unit 01 was not collided with at all. Unit 03 and unit 02 were the only ones that collided. Driver Fisher of unit 03 stated his back hurt, but he did not want the fire department. I called fire for driver James Montgomery as the intrusion to his vehicle was severe. He only complained of a hurt lower lip and face. Driver Elijah F. Montgomery told me that when he turned, he had not seen unit 03 coming. I provided all parties with a business card which contained the case number. I observed that the damage to the vehicles was consistent with what the parties had told me. At the conclusion of my investigation, I determined that driver Elijah F. Montgomery took a left turn without yielding right of way to unit 03. 1 confirmed with driver Elijah F. Montgomery that his DOL address was current. He did not have a valid driver license (expired license) and he told me that he did not have insurance. I informed him that he would be receiving a citation for NVOL with ID, failure to yield right of way, and no insurance via mail. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by B. Flick 12825 on 10-07-2023 in Renton, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EE07090 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-11514 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:4252779773 0 1 29 LAST NAME FISHER FIRST NAME GREGORY MIDDLE D INITIAL STREET 30 NFW AnDRFSP' 16121 1821VD AVE SE CITY RENTON ST WA ZIP 98058 6 ❑ 1 1 2 31 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED INTERLOCK YEs NO NTERLOCK YEs❑N0� YES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 01 - 26 - 1963 7 HELMET :INJURY' NATURE OF INJURIES ON DUTY STATUS AIRBAG 3 RESTR. 4 EJECT 1 USE 2 CLASS 7 BACK PAIN 8 ❑ 1 32 LICENSE BSE7205 TAr WA VIN# WBAGD8326PDE84354 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN It VIN.#. 11 3 5 VEH.YEAR1993 MAKE BMW I MODEL 740 STYLE SD VEHICLE TOWS E T SABLI W_-'•ER G VT VFHIG P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO OWNED BY DRIVER ] 3 33 12 � SHADE IN DAMAGED AREA j 4 FROM TO LIABILITY INSURANCE INSURANCE CO ALLSTATE 076 463 994 q"i"Olx IN EFFECT &POLICY# VEHICLE 10 6QTTUM 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE gg�@, STANDING ❑ dROD RT l:9 7 6 ❑ 35 11 PEDESTRIAN WY � SMNOH OLDMET PHONE 14 UNIT� VEHICLE CYCLE OWNER YE 15 LAST NAME FIRST NAME INITIAL 36 MIDDLE ❑ STRE 16 NFW ETETnnR"� CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK YES NO YES NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY -� II 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ ❑ 41 TRLR TRLR 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 AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEGALLv STANDING S 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BENJAMIN FLICK 10-07-23 06:41 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12825 O#I WA0171300 SCOTT 101812023 PAGE F OF 5 3000-345-013(R 11118) REPORT NO. EE07090 CASE# ' 23-11514 DATE AND TIME 10/07/23 16:50 OF COLLISION N nit 02 Not to scale VVVVVVVVV i st��F SE:Petrovitsky RD -ram as a> m "Unit 41 U m PAGE 5 OF 5