HomeMy WebLinkAbout24-9087 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STIR FIRE CASE
EET ❑
24-so87 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
TRIBAL UNITS 01 STRUCK' TREE OR STUMP
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 08 — 29 — 2024 1342 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S PUGET DR BLOCK NO. e✓ 2400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 250 00 FEET MILES e S ❑ W e 116THAVESE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064509623 30
6F] INITIAL
LAST NAME MAGLEY FIRSTNAME DAVID MIDDLE H 1 1 2 31
STREET El 15702 117TH AVE SE CITY RENTON ST WA 2jp, 980584670 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
$❑ LDICENSE#RIlEfll STATE WA SEX'M I ELMMDDYY 03 - 17 - 1949 32
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H U SE CLASS 7 I UKNRE OF INJURIES 2❑
3
10❑ P1 aT�S� CFD9129 sTAr� WAvIN# 1G11C5SA8DF201770
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
RomM TO
34
13 VEH.YEAR2013 MAKE CHEV MODEL MALIBU STYLE VEHICLE TOWED0NOOffBLIN WAWkkRS yOES❑ENO
DAMAGE IILLJJII tSA1Vi�6
REGISTERED OWNER INFO ..MAGLEY 11702117TH AVE SE RENTON WA 980584670 D:2064509623 VEHICLE NO. 1 ❑
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO TBA
IN EFFECT &POLICY# �1'OP
ve'C ❑ 36
LEGALLv res❑NO❑ CITATION# CHARGE BOTTOM
15❑ NDING
�UITN 02 VE ICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO YES
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLEITIAL
IN
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE LICENSE vIN# 41
PLATE#
42
22 [TRAILER T
❑ PLATE# STATE pLATE#ILER STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
M.LEVERTON 2517 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF10940
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9087
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) AGLIAM CHRIS
(LAST FIRST,
ADDRESS&PHONE#
2062507078 SEX i U MMDDYYYY 10 - 16 - 1987
---------------------------
PASSENGER WITNESS SEAT AIRBAG RESTR. EJECT ' HELMET INJURY : NATURE OF INJURIES
❑ ❑✓S UNIT# POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
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.MMDD -❑
YYYY.
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 08-30-24 02:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 9/2/2024 12:25:29 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED! 1:43 PM TIME POLICE ARRIVED]1:44 PM
PART I PAGE IT]OF 4]
REPORT NO. EF10940 CASE# 24-9087 OF COLLISION
08/29/24 13:42
OF CbLLI510N
NARRATIVE
sv off road medical/medics
RTF
Within the city limits of Renton/King/WA I responded to a single vehicle off the roadway near the 2400
block of S Puget Dr.
The Wit/RP flagged me down because the car was so far into the blackberry bushes. I knocked down
sticker bushes for several minutes getting to the vehicle. I cut out the passenger side airbag over the
window. I located a single male occupant. It was obvious he was in medical distress. I requested
Fire and Medics bases on my observations.
Renton Fire did a full extrication of the driver and Medics treated him on scene and transported him to
VMC-ED for further treatment. His vehicle suffered significant damage from the initial crash and even
more during the unique position the vehicle and driver were in.
Bankers recovered and towed the vehicle for damages.
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 8/30/20204
PAGE 3 OF 4
REPORT NO.! EF10940 CASE# ' 24-9087 DATE AND TIME 08/29/24 13:42
OF COLLISION
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PAGE 4 OF 4