HomeMy WebLinkAbout23-12653 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12653 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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 11 - 1-- 2023 0722 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON DR S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e S 15TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2068493670 0 81
30
6� LAST NAME LLUBIT FIRSTNAME KETH MIDDLE P 1 2 31
INITIAL
STREET ❑ 11020 SE 218TH PL CITY KENT ST WA 2jp, 980311306 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
10❑ P1 aT�S� 192YQU sTATe WA vIN# JTJBT20X280168076
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 2 2008 LEXS GX DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO ROGER LLUB11 11020 SE 218TH PL KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO ST FARM 497.1115-BO1.47A 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3A0681720 FOLLOW VEHICLE TOO CLOSELY I o sorrow
15❑ NDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER
❑ YES 1/ NO D:2063309069
16 a
LAST NAME KIHU FIRST NAME MARTIN MIDDLE G
INITIAL
17❑ STREET ❑', 33338 4OTH AVE SW CITY FEDERAL WAY ST WA ZIP 980232914 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 LDIIVEW # STATE WA SEX M M .C.B. O6 _ 28 _ 1982 0 39
WELMET INJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BOJ3927 TATe WA VIN# JHLRD7847CO23973
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2004 MAKE HOND MODEL CR-V EX STYLE VEHICLE TOWED TO BLIN TOWED By GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MARTIN KIHU 3333840TH AVE SW FEDERAL WAY WA 980232914 D:2063309069 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ST FARM 1437-239-15IN I GD
VE""LE CITATION# CHARGE
LEGALLY YES Nu
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. EE20664
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12653
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'
wht suv/1 nb lane 1 rear read small suv stopped
CC
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the intersection of
Benson Dr S at S 15th St.
I contacted the driver of unit 2 who told me he was stopped at the light lane 1 northbound on Benson
Dr S when he was rear-ended by unit 1. He did not complain of injury and damages did not require a
tow truck.
I contacted the driver of unit 1 ID'd by her picture WADL. She told me she was following unit 2 when
the light changed from green to yellow. She thought unit 2 would continue and she followed him.
Unit 2 stopped for the yellow and she rear-ended him. Unit 1 did not complain of injury and damages
did require a tow truck.
I cited unit 2 ref RCW 46.61.145 Following too closely 2 car crash 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 11/3/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 11-03-23 07:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 1111712023 2:42:05 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 7:23 AM TIME POLICE ARRIVED'7:26 AM
PART I PAGE IT]OF
REPORT NCV EE20664 CASE# ' 2302653 DATE AND TIME 1 1/03/23 07:22
OF COLLISION
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