HomeMy WebLinkAbout23-13752 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-13752 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK' BOULDER
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 11 - 1-- 2023 0711 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S CARR RD BLOCK NO. e✓ 601
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 250 00 FMILES EET e S ❑ E e TALBOT RD S
0 1 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE =30
6F] LAST NAME ROUSH FIRSTNAME DUANE MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 11452 SE 191 ST CT CITY RENTON ST WA Zlp' 980557411 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 06 - 18 - 1962 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� AX23417 sTArI WAvrN# 2FMDK4KC6ABB46148
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
Rom 34
13 VEH.YEAR2010 MAKE FORD MODEL EDGE STYLE VEHICLETOWED0NOOffBLIN TQyED.BLRS yOES❑ENO
DAMAGE IILLJJII ttSSAA1IVV/it�66
REGISTERED OWNER INFO DUANE ROUSH 11452 SE 191ST CT RENTON WA 980557411 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO NAT GENERAL 2020087209 <�3IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# OTTOM
15❑ STAIND'ING 6
UNIT VEHIMOTCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES
✓❑ DYES NO SOLD MET PHONE
16❑
LAST NAME MED FIRST NAME PAC MIDDLE
INITIAL
17❑ STREET ❑', 601 S CARR RD CITY' RENTON ST WA ZIP 98057 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 LLIICENS # STATE SEX U MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE vIN# 41
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
M.LEVERTON 2517 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE26991
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13752
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'
no headlights crashed into rocks
RTF
Within the city limits of Renton/King/WA I responded to a single vehicle into a pork chop island and
high centered on some rocks.
When I arrived I found unit 1 stuck in the dirt and rocks to the lower lot driveway to 601 S Carr S. He
was still seated in the car. He told me he had underlying medical conditions and because of the
elevation of his car I had Renton Fire respond. Unit 1 told me he was just rounding the corner on S
Carr and didnt realize he didnt have his lights on when he merely drove off the roadway not able to
see/negotiate the curve in the road. Renton Fire assisted him getting out of the car and decided to
transport him to VMC-ER. Bankers was able to get his car off the rocks and towed if for damages.
I attempted to locate/notify the building super or owner with negative results. 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 11/30/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 11-30-23 01:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 12/5/2023 11:20:21 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 7:15 AM TIME POLICE ARRIVED 7:22 AM
PART I PAGE IT]OF 3�
REPORT NO. EE26991 CASE# ' 23-13752 DATE AND TIME 11/30/23 07:11
OF COLLISION
nts
601 S Carr Rd
Vba 'r i
4f
i
nit
i
PAGE 3 OF 3