HomeMy WebLinkAbout23-12489 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12489 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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 - 31 - 2023 0735 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 8TH ST
0 1 29
UNIT MOTOR
Z PEDAL-
CYCLE El DAYESMAGE NHORESHOLD MET PHONE 01 0 81
30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYES NO INTERLOCK YES NO YES No
8❑ LICIENSE# STATE SEX u MMDDYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 HELMET U E 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
7
TRAILER STATE TRAILER C STATE
11 3 0 PLATE# PLATE# ROM ro
rRLR. TRLR. 1 5 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE R T 34
13 2 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO [NEW] VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI INSURANCE❑ NSURANCE CO 3 4
LI EFFECT &POLICY#VEwcLE CHARGE 36
LECALLvYEs❑NO CITATION# EQ,
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5094756233
a
LAST NAME DAVEY FIRST NAME MARJORIE MIDDLE M
INITIAL
17❑ STREET NEW ADDRESS❑' 1712 N RIVER VISTA ST CITY SPOKANE ST WA ZIP 992245730 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I No� YES t l NO❑
19CENS STATE WA SEX F I D.MMDDYY 11 02 _ 1996 El 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
❑ILICENSE 21❑ PLA E# AVA8028 TATE 41
WA VIN# JM3ER29L590228469 4
42
22 [TRAILER T
❑ PLATE# STATE PLATE#ILER STATE
23❑ 43
TRLR RLR
VIN#. IN#.
YEAR 2009 MAKE MAZp MODEL CX-7 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
VEH
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JAMES DAVEY 1712 N RIVER VISTA ST SPOKANE WA 99224 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. I 9TOP
VEwcLE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES NEI
❑ s �
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
M.LEVERTON 2517 0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE15382
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12489
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'
sb stoopped at 8th rear lifted truck no id
RTF
Within the city limits of Renton/King/WA I responded to a 2 car hit and run crash at N 8th st on Logan
Ave N.
I contacted the driver of unit 2 who told me she was stopped one car from the light south on Logan
Ave N when she was hit from behind by unit 1. She told me she was not able to see the driver as it
was a large lifted truck with very dark windows. She was not able to even get a license plate, she
said every thing happened so fast and the driver of unit 1 took off quickly. She 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 10/31/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 10-31-23 08:48 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 11/1/2023 3:27:39 PM
BADGE OR ID# 2517 OR]#' [ WA0171300 TIME POLICE DISPATCHED 7:35 AM TIME POLICE ARRIVED',8:22 AM
PART I PAGE IT]OF
REPORT NO.! EE15382 CASE# 23-12489 DATE AND TIME 10/31/23 07:35
OF COLLISION
AIIIIIII
unit 1 nts
unit
PAGE 3 OF 3