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COLLISION REP FIT 1591971
CASE 23-12266 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 10 - 1-- 2023 1023 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
HARDIE AVE SW
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET ❑ S ❑ VV❑ SW 5TH PL
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:3605738382 0 3 30
6� LAST NAME DONG FIRSTNAME KHANG MIDDLE 1 1 2 31
INITIAL
STREET ❑ 11833 55TH AVE S CITY SEATTLE ST WA 2jp, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
❑10 9❑ P1 aT�S� CGN8212 sTArI WWAurN# WBAFU7C5XDDU69185 3
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR. TRLR. 1 5 33
12 2 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 1 7 34
13 2 2013 BMW 535 DAMAGE YES NO MEYER YES[:] NO✓
REGISTERED OWNER INFO KHANG DONG 118.55THAVE S SEATTLE WA 98178 D:3605738382 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP
VE—LL CHARGE to BOTTOM 5 36
EGALLv YES No CITATION# 3A0681713,3A0681713, NO DRIVER'S LICENSE ON PERSON,
15❑ STANDING 6
MOTOR PEDAL-:. PROPERTY
DAM THR OLD MET PHONE
�UNIT�, ❑ ❑ PEDESTRIAN ❑ ❑ D:206861zoos
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME RUSSELL FIRST NAME SHAMIKKA MIDDLE I S
INITIAL
17❑ STREET ❑', 201 SW 5TH PL APT J103 CITY' RENTON ST WA ZIP 980575823 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs❑NOF YES
❑No❑
19 F] DRIVER #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 1
USE CLASS ❑
21❑ LICENSE I CFA8079 TAre WA vIN# 1GIZD5ST5LF115400
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE CHEV MODEL MALIBU STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SHAMIKKARUSSELL201SW5THPLAPTJ103 RENTON WA 980575823 D:2068612009 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE 8 POINSURGY#E CO BRISTOL GOI-2966867-00IN 1 9TOP
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $
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. EE15354
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12266
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'
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 10-26-23 11:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 111112023 2:24:58 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 10:30 AM TIME POLICE ARRIVED',10:34 AM
PART I PAGE IT]OF 4�
REPORT NO. EE15354 CASE# 23-12266 OF COLLISION
10/26/23 10:23
OF CbLLI510N
NARRATIVE
blk sedan/2 rt sb slv sedan rear
CC
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the intersection of
Hardie Ave SW at SW 5th PI.
I contacted the driver of unit 2 who told me she was southbound on Hardie Ave SW and making a
right turn at SW 5th PI where she has lived for about 5 years. She said while she was slowing and
making her turn she was hit from behind by unit 1. She did not complain of injury and damages did
not require a tow truck.
I contacted the driver of unit 1 verbally ID'd and later confirmed via Dispatch as he did not have his
license with him. I asked him what happened and he told me unit 2 actually made a complete stop
prior to making her right turn. I asked him if that was the case in a 25 mph zone he must have been
going very fast in order to have crashed into the back of her and he said I was going too fast. He was
unable to provide valid proof of insurance and damages did require a tow truck.
I contacted unit 2 again who told me in fact did not stop and why would she its a free right turn and is
very familiar with the area.
I cited unit 1 Ref RCW 46.20.017 Fail to carry WADL on person, ref RCW 46.61.525 Negligent driving
Second Degree by driving at such a speed in a posted 25 zone he was unable to avoid hitting a car
making a lawful right turn and ref RCW 46.30.020 No Insurance 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 10/26/2023
PAGE 3 OF 4
REPORT NO.! EE15354 CASE# ' 23-12266 DATE AND TIME 10/26/23 10:23
OF COLLISION
nts
;F.
PAGE 4 OF 4