HomeMy WebLinkAbout23-14064 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 23-14064 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4200 3
HIT&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#
COLLISION.. 12 - 1-- 2023 1523 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
LOGAN AVE S MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5 �,❑ FEET e S ❑ VV e S TOBIN ST
❑
0 $ 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066762853 0 11
30
6� LAST NAME CANTRELL FIRSTNAME ASHLEY MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 21136 127TH PL SE CITY KENT ST WA Zjp, 980312278 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 9❑ P1 aT�S� BDS1090 sTArI WAvIN# KNADM4A36F6432746
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 1 33
12 2 5 VIN#j VIN#
FROM TO
VEH.YEAR 2015 MAKE KIA MODEL RIO STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO SHARON 14OBBS 21136127TH PL SE KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO AARP 55PHT214230 4
LI EFFECT &SUR N# TOPVEHICLE CHARGE 36
LEGALLYYES NO CITATION# 3A0681750 PROHIBITED U TURN <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067780092
16 a
LAST NAME DAM FIRST NAME CHANTREA MIDDLE N
INITIAL
17❑ STREET ❑', 11253 SE 190TH CT CITY RENTON ST WA ZIP 980557149 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 F D.Q.B. 11 04 1978 0 39
LICENSE# MMDDYY
WELMET INJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS HEADACHE ❑
21❑ LICENSE BVL1414 TAre WA vIN1i WDDZF6JB5LA715319
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE MERZ MODEL E STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CHANTREA DAM 11253 SE 190TH CT RENTON WA 98055 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
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. EE32473
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14064
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
PM 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'
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 12-07-23 04:22 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOSS 1953 12/20/2023 10:10:33 AM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED; 3:23 PM TIME POLICE ARRIVED 3:38 PM
PART I PAGE IT]OF 4�
REPORT NO. EE32473 CASE# 23-14064 OF COLLISION
12/07/23 15:23
OF CbLLI510N
NARRATIVE
slv/1 sedan sb tobin then across unit 2 path blk sedan
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Logan Ave S at S Tobin St.
I contacted the driver of unit 2 who told me she was following unit 1 south on Logan when unit 1 made
a right turn onto S Tobin St and as she was passing that roadway unit 1 made a sudden turn into the
side of her car. She did complain of head pain but did not request Fire to respond and would seek
additional medical if necessary. 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 south on Logan and
was turning right onto Logan and at the last minute changed her mind and made a sudden turn
crashing into the side of unit 2. She did not complain of injury and damages did require a tow truck.
I cited unit 1 driver/Cantrell ref RCW 46.61.295 Prohibited U-turn causing a 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 12/07/2023
PAGE 3 OF 4
REPORT NO. EE32473 CASE# ' 23-14064 DATE AND TIME 12/07/23 15:23
OF COLLISION
nts
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