HomeMy WebLinkAbout23-12330 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-12330 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
1 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 10 - 1-- 2023 1426 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGANE AVE N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 3RD ST
0 1 29
UNIT 01 VEHICLE
MOTPI PEDAL-ORCYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 4 30
LAST NAME ALEMAN MARTINEZ FIRST NAME JUNIOR MIDDLE A
6 INITIAL 1 2 31
STREET ❑ 1300 S PUGET DR APT 223 CITY RENTON ST WA 2jp, 98055 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ pl ATFBit BSF8825 sTArI WA vrN# 4T18E32K23U196770
F_ T #RAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE FROM To
TRLR. TRLR $ 1 33
vIN#
12 3 0 ' VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 3 34
13 2 2003 TOYT CAMRY DAMAGE vE5 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO WILFREDO ALEMAN MARTINEZ 1300 S PUGET DR APT 223 RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
15❑ LE
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 10 BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES�/ No D:2532556744
16 a
LAST NAME MC MAHON FIRST NAME WINSTON MIDDLE I S
INITIAL
17❑ STREET ❑', 16908 166TH PL SE CITY' RENTON ST WA ZIP 980584202 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 LDIIVEW # STATE WA SEX M M .C... 12 _ 21 1981 El 39
HELMET I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE D66752D TAre WA vlNli 1GTUUGE85RZ110676
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2024 MAKE GMC MODEL SIERRA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO WINSTON MC MAHON 16908166TH PL SE RENTON WA 980584202 D:2532556744 VEHICLE NO.2
SHADE IN DAGELLAREA
z Cdd
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 01322 43 92RIN IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
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. EE15384
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12330
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 10-27-23 03:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 111112023 2:31:08 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 2:26 Pry TIME POLICE ARRIVED',2:26 PM
PART I PAGE IT]OF 4�
REPORT NO. EE15384 CASE# 23-12330 OF COLLISION
10/27/23 14:26
OF CbLLI510N
NARRATIVE
blk trk/2 It to n 3rd blk sedan nb lane 1 no lic green
RTF
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the intersection of
Logan Ave N at N 3rd St.
I contacted the driver of unit 2 who told me he was attempting to make a left turn on his flashing
yellow, while lane 2 NB was stopped he believed he could make the turn across lane 1 which
appeared to be clear when he was hit by unit 1. He did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 1 who told me he was in lane 1 NB Logan Ave N and while traffic in lane
2 was stopped his lane was open and his light was green. As he continued NB unit 2 turned left in
front of him when they contacted. He did not complain of injury. His unknown passenger was check
and released by Renton Fire onscene. She did ID herself. Damages to his vehicle required 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
PAGE 3 OF 4
REPORT NO.! EE15384 CASE# ' 23-12330 DATE AND TIME 10/27/23 14:26
OF COLLISION
ti
nts
F
nyb
{
i
PAGE 4 OF 4