HomeMy WebLinkAbout24-308 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE z4-3o8 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
COLLISION'. 01 - 09 - 2024 1419 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e S 3RD ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067756968 0 11
30
6� LAST NAME WALKER FIRSTNAME RYAN MIDDLE S 1 2 31
INITIAL
STREET ❑ 16638 106TH AVE SE CITY RENTON ST WA ZIP 98055 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ DRILICVERS
# STATE SEX u MMDOBYY os - 02 - 1s77 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 aT�S� BST0434 sTArI WAvIN# 1LNLM91V3VY690573
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. YRLR. 3 1 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 1997 LING MARK DAMAGE YES NO ✓ YES : NO✓
REGISTERED OWNER INFO ..PAL.11138106TH AVE SE RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# FAIL YIELD PRIVATE RD MOTOR I o eorrom
15❑ STAIN.D'ING 7 6
UNIT 02 VE IMOTOCLE CYCLE ❑ PEDESTRIAN ❑ OWNER PEDAL
❑ DYES✓AM FI rl
OLD MET PHONE
16 a
LAST NAME BARADI FIRST NAME TIBURCIO MIDDLE A
INITIAL
17❑ STREET ❑', 3007 S CHICAGO ST CITY SEATTLE ST WA ZIP 981083920 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. O6 _ 17 1935 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CHE7956 TAre WA VIN# 2TIBURHE9KC232588
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2019 MAKE TOYT MODEL COROLL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO VIRGINIA BARAD13007 S CHICAGO ST SEATTLE WA 98108 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IGQI
'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. EE39527
COLLISION REPORT III III III III III 111
1591972 CASE# 24-308
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 01-11-24 11:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1/1112024 1:37:58 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 2:29 Pry TIME POLICE ARRIVED]2:24 PM
PART I PAGE IT]OF 4�
REPORT NO. EE39527 CASE# 24-308 OF COLLISION
01/09/24 14:19
OF CbLLI510N
NARRATIVE
1/wht trk from 7-11 pl blk/2 sedan 2nd Itl
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash near the 300 block of
Rainier Ave S.
I contacted the driver of unit 2 who told me he was in the left turn lane when unit 1 hit his vehicle
forcing him onto the lane median. He did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 ID'd by a previous booking photo. Unit 1 was cooperative and
unsolicited provided information regarding the crash including responsibility. He told me he was
turning out of the parking lot of 7-11 trying to get over into the left turn lane and drove into the front
passenger fender of unit 2. He did not complain of injury and damages did not require a tow truck.
I cited unit 1 ref RCW 46.61.205 FTYROW from a private driveway 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 1/10/2024
PAGE 3 OF 4
REPORT NO. EE39527 CASE# ' 24-308 DATE AND TIME 01/09/24 14:19
OF COLLISION
7-11
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PAGE 4 OF 4