HomeMy WebLinkAbout23-11835 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-11835 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 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 10 - 1-- 2023 0705 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
NE 4T ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ �,❑ FEET e S ❑ W e DUVAL!AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066129102 0 11
30
6� LAST NAME CARON FIRSTNAME DYLAN MIDDLE B 1 2 31
INITIAL
STREET ❑, 2116 SE 22ND P! CITY RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� CHP9338 sTArI WAvIN# 3N10E2CP5FL359684
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 ] 34
13 2 2015 NISS VERSA DAMAGE vEs 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO DYLAN CARON 2116 SE 22ND PL RENTON WA 98055 D:2066129102 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
❑ ❑ INSURANCE CO 3 4
14 LIABILI V INSURANCE SAME.
IN EFFECT &POLICY# 9TOP
VEH" CHARGE to BOTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 3A0681706,3A0681706, FAIL YIELD LEFT TURN MOTOR
15❑ STAIND'ING 6
UNIT VE IMOTOCLE CYCLE PEDAL- ❑ PEDESTRIAN OWNER
[:]LA.
DYES�/ NO OLD MET PHONE
16 a
LAST NAME MEAS FIRST NAME MOLINA MIDDLE N
INITIAL
17❑ STREET ❑', 14237 145TH PL SE CITY' RENTON ST WA ZIP 980595520 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 !DINES # STATE WA ]SEX IF M .C.B. 04 02 _ 1981 0 39
20❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIEs ❑ 40
USE CLASS CHEST
21❑ LICENSE BTD9052 TArE WA VIN# 5J8TC2H79LL037571
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2020 MAKE ACUR MODEL RDX STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO THEARY ROMEO 14237145TH PL SE RENTONWA98059 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10857
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11835
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JACOBSON DARW/N
(LAST FIRST,
ADDRESS&PHONE# D O.B.
SEX U MMDDYYYY 10 - 15 - 1980
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY : NATURE OF INJURIES
❑ �' POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O 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.MMDD -❑
YYYY.
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 10-17-23 09:09 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1011912023 10:38:54 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED! 7:06 AM TIME POLICE ARRIVED 7:12 AM
PART I PAGE IT]OF 4]
REPORT NO. EE10857 CASE# 23-11835 OF COLLISION
10/17/23 07:05
OF CbLLI510N
NARRATIVE
slv left turn on yellow flasg wht suv wb In 2
CC
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the intersection of
NE 4th St at Duvall Ave NE.
I contacted the driver of unit 2 who told me she was westbound in lane 2 on her green light when unit
1 turned left in front of her car with no room to avoid unit 1. She was treated and released on scene
by Renton Fire. Her car was towed for damages.
I contacted the driver of unit 1 who ID'd himself with a medical document. He was unable to produce
a drivers license or his vehicle registration. He mother arrived on scene and was able to provide
proof of insurance. He told me the crashed was caused by him not yielding to on coming traffic while
turning left from EB NE 4th St to NB Duvall Ave NE. He said he was just following other traffic through
the light. He told me his light was a flashing yellow, which requires him to yield to opposing traffic. He
was treated and released on scene by Renton Fire. His vehicle required a tow truck for severe
damages.
I cited Unit 1 ref RCW 46.61.185 FRYROW-Left turn 2 car crash with injury, ref RCW 46.16A.180 Fail
to carry/provide registration and ref RCW 46.20.017 fail to carry drivers license 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 10/17/2023
PAGE 3 OF 4
REPORT NO.! EE10857 CASE# 23-11835 DATE AND TIME 10/17/23 07:05
OF COLLISION
nts
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PAGE 4 OF 4