HomeMy WebLinkAbout24-2823 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-2823 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
cawsloN 03 - 1-- 2024 0807 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE 139TH PL MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e 164 AVE SE
0 1 29
UNIT MOTOR
Z PEDDAL ElD MYESA,GEE NHORESHOLD MET PHONE 0 9 30
01 6� LAST NAME BRANDT FIRSTNAME MICHAEL MIDDLE T 1 2 31
INITIAL
STREET ❑, 16221 SE 139TH CT CITY RENTON ST WA 21p' 980597850 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 USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1ATE14 D96577D STATE WA - 1C6SRFHTXNN446917
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12 0 0 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 2 2022 RAM 1500 DAMAGE vE5 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO MICHAEL,BRANDT 11221 SE 139TH CT RENTON INA 98059 D:4254428035 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# 9TOP
15❑ LE
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�NiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069991854
16 a
LAST NAME BISHOP FIRST NAME AARON MIDDLE A
INITIAL
17❑ STREET ❑', 16310 SE 138TH PL CITY RENTON ST WA ZIP 980590000 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.Q.B. 03 _ 13 _ 1979 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE AHR4185 TATe WA vIN# 5TDBK3EH1AS024194
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE TOYT MODEL HIGHLAN STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO AARON BISHOP 16310 SE 138TH PL RENTON WA 980590000 D:2069991854 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ST FARM 1542003-E15-47BIN I 5
vE""LE CITATION# CHARGE
LEG UR
ALLYYES NEI
25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE62768
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2823
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'
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 03-19-24 11:44 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 3/26/2024 2:06:46 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 8:08 AM TIME POLICE ARRIVED 8:23 AM
PART I PAGE IT]OF 4�
REPORT NO. EE62768 CASE# 24-2823 OF COLLISION
03/15/24 08:07
OF CbLLI510N
NARRATIVE
blk/trk/1 sun blind wht suv/2
RTF
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
SE 139th PI and 164th Ave SE.
I contacted the driver of unit 2 who told me he had turned left from 164th onto 139th when he saw unit
1 more on his side of the roadway. He told me he scooted all the way to the raised curbing as
indicated my tire marks and came to a stop to avoid unit 1, but was hit my unit 1. He did not complain
of injury and damages required a tow truck.
I contacted the driver of unit 1 who told me that in this neighborhood the roads are more narrow and
the garbage cans were out on 139th making his lane travel moved more towards the north side of the
road. He said the sun was so bright he was struggling to see and did not even see unit 2 unit he
actually contacted his vehicle. He said he wasnt going but about a jogging speed, but it made him
lose his ability to steer after the crash. His vehicle was tow for damages and he did not complain of
injury.
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 3/19/2024
PAGE 3 OF 4
REPORT NO. EE62768 CASE# ' 24-2823 DATE AND TIME 03/15/24 08:07
OF COLLISION
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