HomeMy WebLinkAbout24-259 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE# z4-zss 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
COLLISION.. 01 - 08 - 2024 1405 17 . N E IN� S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
L1ND AVE SW BLOCK NO. e✓ 4100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW41ST ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2533046667 0 11
30
6� LAST NAME LAVERTY FIRSTNAME CALEB MIDDLE B 1 2 31
INITIAL
STREET ❑✓ 15347 BERRY VALLEY RD SE CITY YELM ST WA 7jp, 98597 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
LICENSE C69541U STATE WA uN# 1GCCS1445S8137336
10 1❑ PI ATE�
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IRM ro
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 5 1 34
13 2 1995 CHEV S10 1'K DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO AARON CARROLL BONNEY LAKE WA 98391 D:2534311629 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO eq�T3 4
IN EFFECT &POLICY# 9TOP
VEH'CLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ NDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:][LAM ES 1/ No D:2065784035
16 a
LAST NAME TRAN FIRST NAME THAD MIDDLE H
INITIAL
17❑ STREET ❑', 20024 106TH AVE SE CITY KENT ST WA ZIP 98031 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 D IVEW #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE BTM6059 TATE WA vIN# 4T4BE46KX8R039324
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2008 MAKE TOYT MODEL CAMRY STYLE qD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO LONG TRAN 14600 SE 176TH ST UNIT U4 RENTONWA 98058 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#E CO STATE FARM 390 5216-C31-47AIN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s 7 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.STEED 8770 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE38376
COLLISION REPORT III III III III III 111
1591972 CASE# 24-259
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'
On 1/08/24 at about 1413 hrs I arrived at Lind Ave SW and SW 41 st St for a non-injury collision, in
the City of Renton, County of King, and State of Washington. Unit#1 was SB on Lind Ave SW in the
inside lane. The driver of Unit#1 said he went to accelerate to pass a vehicle to get over when his
rear tires lost traction in the rain. Unit#1 began to fishtail which caused him to enter the oncoming
lane where Unit#2 was traveling NB in the inside lane of Lind Ave SW. Unit#1 struck Unit#2 with the
front passenger side bumper of his vehicle to the front passenger side of Unit#2 causing extensive
damage. There were no reported injuries.
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized. The video was uploaded to evidence.com.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed by Officer Steed on 1/08/24 1510 hrs, Renton Washington
Cassidy Steed/8770
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.STEED 01-08-24 03:11 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1/8/2024 3:24:45 PM
BADGE OR ID# 8770 OR]# ! WA0171300 TIME POLICE DISPATCHED 2:10 PM TIME POLICE ARRIVED 2:13 PM
PART I PAGE IT]OF 3�
REPORT NO. EE38376 CASE# ' 24-259 DATE AND TIME 01/08/24 14:05
OF COLLISION
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