HomeMy WebLinkAbout23-12613 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-12613 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 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# ❑
cawsloN 11 - 1-- 2023 1209 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 2100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e S 21ST ST
1 6 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:4259029601 0 11
30
6� INITIAL
LAST NAME JAWARA FIRSTNAME VICTORIOS MIDDLE S 1 1 2 31
STREET ❑ 32200 MILITARY RD S APT R101 CITY FEDERAL WAY ST WA Zjp, 980015121 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'F MID
.O B 07 1- 02 - 2003 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ PI ATE 14 CGH8692 STATE WA VIN#' 2HNYD182X2H548437
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# IR.. ro
TRLR. TRLR. 5 1 33
12 3 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 1 $ 34
13 2 2002 ACUR MDX DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO VICTORIOS JAWARA 32200 MILITARY RD S APT R101 FEDERAL WAY WA 98001 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP
VE— CHARGE to BOTTOM 5 36
LEGALLI YES NO CITATION# 3A0681718,3A0681718, FLD TO DRIVE ON RIGHT SIDE OF
15❑ NDING 6
UNIT ' MOTOR PEDAL ❑ PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLD MET PHONE
16 a VEHICLE CYCLE : OWNER
LAST NAME MC COY FIRST NAME BRUCE MIDDLE A
INITIAL
17❑ STREET ❑', 1561E TIMBERLAKE EAST DR CITY SHELTON ST WA ZIP 985847925 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[—] LDI IVER # STATE WA SEX M M D.C.B. 04 23 _ 1956 0 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE AOM8504 TATe WA vlN. JTLKT334264095246
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2006 MAKE TOYT MODEL SCION STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO BRUCE MCCOY 1561 E TIMBERLAKE EAST DR SHELTON WA 98584 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU POLICY#E CO pROGRESSIVETBAIN STOP 5
VE""LE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' a
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. EE15742
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12613
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MANWEILER IRENE J
(LAST FIRST,
ADDRESS&PHONE#
1561 E TIMBERLAKE EAST DR SHELTON WA 985847925 2533355270 SEXi F MMDOYyry 10 - 15 - 1956
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 2 POS. 3 AIRBAG 6 RESTR. q EJECT USE CLASS 7 CHEST
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# BEd MMDDYYYY DOB
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 11-02-23 01:20 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
c0.JOPINSON 0505 111212023 5:44:53 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 12:10 PM TIME POLICE ARRIVED',12:12 PM
PART I PAGE IT]OF 4�
REPORT NO. EE15742 CASE# 23-12613 OF COLLISION
11/02/23 12:09
OF CbLLI510N
NARRATIVE
silver suv/1 loc head on slv/2 head on injury
CC
Within the city limits of Renton/King/WA I responded to a 2 car head on blocking injury crash at about
the 2100 block of Talbot Rd S.
When I arrived Tri-Med was on scene providing first aid the the injured.
I contacted the driver of unit 2 who told me he was south on Talbot Rd S when unit 1 went left of
center and crashed head on into his car. He said it happened so fast. He had obvious injuries from
the crash to include broken bone(s). He was treated on scene and transported to VMC-ER by Renton
Fire. Damages required a tow truck. Unit 2 passenger was also injured and was treated by Renton
Fire on scene and later transported to VMC-ER by Tri-Med.
I contacted the driver of unit 1 ID'd by her picture WADL. She was somewhat flippant about the
crash. Basically provided no information about what happened other than she was in a crash and
was making an effort to leave the scene. She was reminded several times to remain on scene during
the investigation. She did not complain of injury and damages did require a tow truck. Unit 1 did not
provide valid proof of insurance upon request.
From looking at POI and POR it was clear to me that unit 1 was traveling left of center in the head on
lane northbound in the southbound lanes. This is a two lane N/S road divided with a double yellow
center line. There did not appear to be any length of tire marks from panic braking pre-collision. Both
cars had remarkable front end damage.
I cited unit 1 Ref RCW 46.61.100 driving left of center 2 car injury crash, ref RCW 46.61.525
Negligent driving second degree 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 11/2/2023
PAGE 3 OF 4
REPORT NO.! EE15742 CASE# ' 23-12613 DATE AND TIME 11/02/23 12:09
OF COLLISION
Scene Not Observed
PAGE 4 OF 4