HomeMy WebLinkAbout23-12323 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12323 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 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#
cowsloN 10 - 1-- 2023 1016 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 ❑ VV a SW SUNSET BLVD
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2537979457 0 7 30
6� LAST NAME HEIER FIRSTNAME JOSEPH MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 1317 G ST SE CITY AUBURN ST WA ZIP 980026735 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� PT01526 sTATe WA urN# 1HGCE1899RA008310
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 0 0 VIN#j VIN#
FROM TO
VEH.YEAR 994 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 r 1 HOND ACDSW DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO JOSEPHHEIER 1317G STSE AUBURN WA 980026735 D:2537979457 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO FARMERS 193634386 3 4
IN EFFECT &POLICY# 9TOP
VE—LE 5 36
LEGALLY
YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069407782
16 a
LAST NAME CO KEY FIRST NAME ROBIN MIDDLE I D
INITIAL
17❑ STREET ❑', 8033 S 128TH ST CITY SEATTLE ST WA ZIP 981784939 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA ]SEX IF D.Q.B. 12 _ 05 _ 1969 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE AJH3513 TATe WA VIN# JTMBK31V976019426
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2007 MAKE TOYT MODEL RAV4 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO DIANE CASAVIEJA 8033 S 128TH ST SEATTLE WA 98178 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. I Q
vE"'LE ❑ ,zCITATION# CHARGEi o
LEGALLY YES N
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE15383
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12323
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'
drk blu wagon/unit 1 lane 2 sb rear unit 2 suv lit blu
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash at the intersection of Rainier
Ave S at SW Sunset Blvd.
I contacted the driver of unit 2 who told me she was on her green light southbound lane 2 when a 3rd
vehicle came to a sudden stop in the middle of the intersection for no apparent reason and remained
stationary for about 30 seconds before speeding off. Unit 2 told me while she was making a panic
brake she was contacted by unit 1 from behind. She did not complain of injury and she requested a
tow truck for damages.
I contacted the driver of unit 1 who told me he was following unit 2 through the intersection when a
3rd car stopped for no reason and it caused him and unit 2 to panic brake. He told me he almost
avoided unit 2 but still got the back end of her car. He did not complain of injury and damages did not
require a tow truck.
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 10/27/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 10-27-23 03:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 11/1/2023 2:29:06 PM
BADGE OR ID# 2517 OR]#' [ WA0171300 TIME POLICE DISPATCHED; 10:21 AM TIME POLICE ARRIVED',10:27 AM
PART I PAGE IT]OF
REPORT NO.! EE15383 CASE# ' 23-12323 DATE AND TIME 10/27/23 10:16
OF COLLISION
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