HomeMy WebLinkAbout23-12335 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12335 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 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#
cawsloN 10 - 1-- 2023 1537 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE 180TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 108THAVESE
0 3 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD MET PHONE 0 1 30
6� LAST NAME EL-ASHI FIRSTNAME NOURELDEAN MIDDLE A 1 2 31
INITIAL
STREET ❑ 1003 S 47TH ST CITY RENTON ST WA 21p, 980557325 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 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CHD9186 sTArI WAurN# W1NOG8EB8NG066064
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 5 33
12 4 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 34
13 2 2022 MERZ GLC DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO TASNIM KHALIL 10.S 47TH ST RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO <53 4LIABILITY INSURANCEIN EFFECT &POLICV# Q
vewcLE CHARGE 5 36
LEGALLY YES❑NO CITATION# 3A0681714,3A0681714 FAIL TO OBEY TRAFFIC CONTROL
15❑ STANDING 7
UNIT�' MOTOR PEDAL- ❑ PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLD MET PHONE
VEHICLE 16 a CYCLE OWNER YES 1/ NO
LAST NAME HERGERT FIRST NAME SANDRA MIDDLE I,I
INITIAL
17❑ STREET ❑', 13225 SE 187TH PL CITY' RENTON ST WA ZIP 980588028 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs It I NOF YES
t t- l NO❑
19 F] DRIVER # STATE WA SEX F M D.C.B. 01 25 _ 1963 El 39
WELMET INJURY NATURE OF INJURIES 4O
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE I CLASS 1 ❑
21❑ LICENSE I D62680C TAre I WA VIN1i 1GCGTCEN2M1297820
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE CHEV MODEL COLORA STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO
REGISTERED OWNER INFO SANDRA HERGERT 13225SE 18711 PL RENTON WA 98058 VEHICLE NO.2
SHADE DA GEbAREA
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IGQVE""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
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE15385
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12335
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'
Within the city limits of Renton/King/WA I responded to a 2 car blocking at the intersection of 108th
Ave SE at SE 180th St.
Renton Officer G Bills on viewed the crash and told me the following. Unit 2 was southbound on a
green light 108th Ave SE crossing the insection of SE 180th St when unit 1 made a right turn on red
striking unit 2. Unit 2 was checked and released on scene by Renton Fire and damages required a
tow truck.
Bills told me unit 1 made a right turn on red failing to yield to unit 2 contacting the side of unit 2. Unit
1 driver did not complain of injury and damages did not require a tow truck. Unit 1 was unable to
provide valid proof of insurance. Unit 1 was ID'd by picture WADL.
I cited unit 1 ref RCW 46.61.055 FTCWTCD-Red Light right turn when not clear 2 car crash and ref
RCW 46.30.020 no valid proof of 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 10/27/2023
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 04:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 11/1/2023 2:33:51 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 3:37 PM TIME POLICE ARRIVED 3:37 PM
PART I PAGE IT]OF
REPORT NO.! EE15385 CASE# ' 23-12335 DATE AND TIME 10/27/23 15:37
OF COLLISION
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