HomeMy WebLinkAbout23-13919 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13919 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 12 - 1-- 2023 0651 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY SE BLOCK NO. e✓ 15600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 2501. 00 FEET MILES e S B W e SE 156TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/NO D:2069006802 0 7 30
6� LAST NAME BUNNAG FIRSTNAME CHANATAN MIDDLE G 1 1 2 31
INITIAL
STREET El 12604 SE 185TH PL CITY RENTON ST WA Zlp' 980587923 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVERS STATE WA SEX'M MID
-O B 11 1- 08 - 1991 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BYJ4450 sTArI WAVIN# JTEBU5JR1M5877060
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 0 0 VIN If uIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED fn TO VKIN TOWED BY GOVT.VEHICLE J 9 34
13 2021 TOYT 4RUNNE DAMAGE vesNo ves❑ No✓
REGISTEREDOWNERINFO CHANATANBUNNAG12604SE185THPL RENTON WA 980587923 D:2069006802 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE U INSURANCE CO GEICO 4601408612 2 3 4
IN EFFECT &POLICY# 9T01
VE—LE CHARGE 5 36
LEGALLv res No CITATION# 3A0681744 FOLLOW VEHICLE TOO CLOSELY o BorroM
15❑ STANDING 8 6
UNIT MOTOVEHIOR Z CYCLE ❑ PEDESTRIAN ❑ PRO ERRTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME WRIGHT FIRST NAME MAREK MIDDLE H
INITIAL
17❑ STREET ❑', 18328 130TH AVE SE CITY' RENTON ST WA ZIP 980587900 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❑
19 DRIVER'S STATE WA SEX M D.C... O6 _ 21 2008 39
LICENSE# MMDDYY
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I BPN8014 TATE WA VIN# KNMAT2MV8JP586890
El41
PLATE#
42
22❑ PLATE# STATE PLATE ILER# STATE El
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR 2018 MAKE NIS$ MODEL ROGUE STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO CLIFTON WRIGHT 18328130THAVE SE RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#E CO USAA 00424 42 73CIN 1 GD
VE""LE CITATION# CHARGELEG25
ALLY YES Nu
❑ s a
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. EE32468
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13919
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WRIGHT CAMILLE H
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
18328 130TH AVE SE RENTON WA 980587900 SEXi F MMDDYyry 08 - 10 - 1969
PASSENGER Z WITNESS❑' EAT USE CLASS UNIT# 2 POS. 3 AIRBAG 2 RESTR. q EJECT ? 1 HELMET LASS NATURE OF INJURIES
' '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYyYY
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE
CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT HELMET AIRBAG RESTR. EJECT ON URE OF INJURIES
NAT
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
slv/suv 1 lane 1 rear blk/wagon 2
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking at about the 15600 block of
140th Way SE.
I contacted the driver of unit 2 who told me he was slowing for traffic and then had to make a quick
stop for traffic when he was hit from behind by unit 1. He and his passenger did not complain of injury
and damages did require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he braked but slid into the back
of unit 2 while stopping for traffic. He did not complain of injury and damages did not require a tow
truck.
I cited unit 1 ref RCW 46.61.145 Following too close 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 126/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 12-06-23 06:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 12/20/2023 10:05:18 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 6:52 AM TIME POLICE ARRIVED'6:58 AM
PART I PAGE IT]OF 3�
REPORT NCV EE32468 CASE# 23-13919 DATE AND TIME 12/05/23 06:51
OF COLLISION
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