HomeMy WebLinkAbout23-14088 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-14088 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
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#
COLLISION.. 12 - 1-— 2023 1048 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
S 2ND ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ W e W/L!IAMS AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:3602969175 0 11
30
6� LAST NAME PETERSON FIRSTNAME HANNAH MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 1320 LAKEWAY DR APT 268 CITY BELLINGHAM ST WA 2jp, 982292024 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❑ Pi aT�S� ACC9035 sTArI WAvIN# 1 NXBR32E97Z814090
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34
13 1 2007 TOYT COROL DAMAGE YES NO � �MEYER YES❑ No✓
REGISTERED OWNER INFO TIMOTHYDAVIS 1223656TH PL S SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE NSURANCE CO ST FARM 5262257EO1 47 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE36
LEGALLv Yes❑NO CITATION# <1�3
OTTOM
15❑ STAIN.D'ING 7 6
UNIT VEHIMOTCLE CYCLE ❑ PEDESTRIAN ❑ OWNER PEDAL RTY ❑ DYES✓ NO OLDMET PHONE
16 a
LAST NAME FITZGERALD FIRST NAME MARISSA MIDDLE I,I
INITIAL
17❑ STREET ❑', 13025 64TH AVE S APT 3 CITY SEATTLE ST WA ZIP 981784617 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES❑NOF INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER # STATE WA SEX F M .O.B. 01 28 _ 1992 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY� STATUS' AIRBAG 4 RESTR 4 EJECT '1 USE CLASS 7 RIGHT ARM
21❑ LICENSE BWG9927 TAre WA VIN1i KNMAT2MV3KP506297
❑ 41
PLATE#
42
22❑ PLATILER E# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2019 MAKE NISS MODEL ROGUE STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO✓
REGISTERED OWNER INFO MARISSA FITZGERALD 210 LOTTIE ST BELLINGHAM WA 98225 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSURANCE
#E CO FARMERS 188603403IN 1GQVE""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. EE32478
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14088
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DAVIS TIMOTHYE
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
12236 56TH PL S SEATTLE WA 981783504 SEX M MMDDYyry 08 - 23 - 1985
PASSENGER WITNESS❑'UNIT# 1 PEA 3 AIRBAG 2 RESTR. 4 EJECT ? HELMET INJURY NATURE OF INJURIES
OS, USE CLASS !1
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# Ly O B
Ex 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 AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
slv sedan/1 webt lane 2 blk suv on green sb
rtf
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at S 2nd St and
Williams Ave S.
i contacted the driver of unit 2 who remained seated in the driver seat complaining of arm pain.
Renton Fire treated and transported her to VMC-ER for additional checks. She told me she was on
her green light when she was hit and spun out by unit 1. Damages required a tow truck.
I contacted the driver of unit 1 who told me she did not notice her traffic light when she contacted unit
2. She was apologetic. She told me she was in lane 2 when the collision took place. She and her
passenger did not complain of injury and damages required a tow truck.
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 12/8/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 12-08-23 11:57 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/20/2023 10:04:49 AM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED' 10:48 AM TIME POLICE ARRIVED 10:49 AM
PART I PAGE IT]OF 3�
REPORT NO. EE32478 CASE# ' 23-14088 DATE AND TIME 12/08/23 10:48
OF COLLISION
nts
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