HomeMy WebLinkAbout24-619 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-s1s 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 5 3 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 — 16 — 2024 1313 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 3900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 150 00 FEET e S ❑ E e UNION AVE NE❑
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4255039983 30
6� LAST NAME WHALEN-ARNOLD FIRSTNAME TRACEY MIDDLE A 1 2 31
INITIAL
STREET ❑, 15232 SE 176TH ST CITY RENTON ST WA ZIP 980589014 2
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ Pi AT 14 CCX9486 STATE WA VIN# 1 C4JJXP68NW114532
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR 1 7 33
12❑ VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE ] 3 34
13 3 2022 JEEP WRANG DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO TRACEYWHALEN-ARNOLD 15232 SE 176TH ST RENTON INA 980589014 D:4255039983 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE TBA 3 4
IN EFFECT &POLICY# 9TOP
vEwcLE CHARGE 5 36
LEGALLY res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2066416832
16 a
LAST NAME NCIS FIRST NAME PATRICIA MIDDLE I J
INITIAL
17❑ STREET ❑', 3788 NE 4TH ST APT J108 CITY RENTON ST WA ZIP 980568482 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 DRIVE # STATE SEX F MMDDW 07 O6 _ 1949 39
ON DUTY STATUS 3 AIRBAG RESTR EJECT , HELMET I INJURY 7 NATURE OF INJURIES 40
USE CLASS L LEG/CALF
❑21❑ TATE LICENSE vIN1i 41
PLATE#
42
22❑ PIR TRAILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 1 ] 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 I 9TOP 5
vE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES Nu
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
M.LEVERTON 2517 [V7�ENCY
A0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE44305
COLLISION REPORT III III III III III 111
1591972 CASE# 24-619
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
PM 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 01-18-24 03:56 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1/25/2024 2:08:33 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED! 1:15 PM TIME POLICE ARRIVED',1:17 PM
PART I PAGE IT]OF 4�
REPORT NO. EE44305 CASE# 24-619 OF COLLISION
01/18/24 13:13
OF CbLLI510N
NARRATIVE
ped crossing east blue jeep making right 3909
Within the city limits of Renton/King/WA I responded to a car v ped collision at 3909 NE 4th St.
When I arrived I contacted the driver of unit 1 who said the Ped was seated inside her Jeep, front
passenger seat.
I contacted the Ped who told me she was walking towards Walgreen's and was contacted by unit 1 in
the driveway apron of the business complex. She complained of left leg pain. She was treated and
released on scene by Renton Fire.
I contacted the driver of unit 1 who told me she was making a right turn from the parking lot and
although she said she checked did not see the Ped. She told me she blocked the roadway and
checked on the Ped who was up and walking right away.
The ped was very short and unit 1 jeep was somewhat tall. The contact was at the passenger door
with very little evidence contact was made. The contact was slight. The Ped just wanted to get to
Walgreen's and not fuss with the police.
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 1/18/2024
PAGE 3 OF 4
REPORT NO. EE44305 CASE# 24-619 DATE AND TIME 01/18/2413:13
OF COLLISION
3
tt
PAGE 4 OF 4