HomeMy WebLinkAbout23-13141 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13141 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 1515 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
OAKESDALEAVESW ST e✓
MILEPOST 1200
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET e SMILES N B W e SWGRADY WAY
2 0 29
UNIT 01 VEHICLE CYCLE ElYES
A�NOGE ESHOLDMET PHONE Q 6 30
6� LAST NAME ADAM ALI FIRSTNAME NURALDAIM MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 3721 S 180TH ST APT A117 CITY SEATAC ST WA Zjp, 981884598 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVERS STATE WA SEX'M MM DAY' 08 1— 15 — 1982 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE CGK8633 sTArI WAurN# JTDKN3DUXC5461593
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 34
13 2 2012 TOYT PRIUS DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO NURALDAIM ADAM ALI 3721 S 180TH STAPTA115 SEATAC WA 98188 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 6070647232 3 4
IN EFFECT &POLICY# 9TOP
VE—LE 5 36
LEGALLY
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STA''ING 6
UNIT a2 VE ICCMOTOLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO �OLDMET PHONE
16 a
LAST NAME HOOD FIRST NAME COLTEN MIDDLE I D
INITIAL
17❑ STREET ❑', 1416 W JAMES CT APT K11 CITY KENT ST WA ZIP 980324355 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑ 11
19 LDIIVER # STATE WA SEX M M .C... 01 04 2000 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C62440H TAre WA VIN# 1C6RR7GT8DS688109
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2013 MAKE RAM MODEL 1500 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO COLTEN HOOD 6821 UDALL PL SE APT G308 AUBURN WA 98092 D:2064919918 VEHICLE NO.2
SHADE IN DAGELLAREA
z Cdd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 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. EE23160
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13141
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'
blk trk/2 Itl slowing wht prius /1 changing into Itl
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash near the intersectino of SW
Grady way on Oaksedale Ave SW.
I contacted the driver of unit 2 who told me he was in the 2wcltl and almost stopped at the stop bar
when he was hit by unit 1 who changed lanes into the side of him. He did not complain of injury and
damages did not require a tow truck.
I contacted the driver of unit 1 who said unit 2 was way back behind him, that he signaled and began
to move over into the left lane, but unit 2 was going too fast. I asked him if unit 2 was going too fast
why did he change lanes. He told me he signaled and he belived he had room. He did not complain
of injury and damages did not require a tow truck.
No witnessess to clarify or cooberate either drivers version of the crash. 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 11/15/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 11-15-23 04:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 11/25/2023 7:15:02 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 3:17 PM TIME POLICE ARRIVED',3:30 PM
PART I PAGE IT]OF 3�
REPORT NO. EE23160 CASE# ' 23-13141 DATE AND TIME 11/14/23 15:15
OF COLLISION
nts
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