HomeMy WebLinkAbout24-1333 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-1333 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AOENC 4Y00 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# ❑
COLLISION 02 - 1-- 2024 0827 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 1800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 500 00 FMILES EET e S ❑ E e SUNSET BL N
0 1 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 8 30
6 LAST NAME HEINEMAN FIRST NAME JOSIAH J MIDDLE 1 2 31
INITIAL
STREET ❑ 18840 SE 216TH ST CITY RENTON ST WA ZIP 98058 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 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10[1P1 ATE 14 CKU3404 STATE WA V N# 3FA6POH71FR12858
11[-� TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 9 34
13 2 2015 FORD FOCUS DAMAGE vE5 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO JOSIAHJHEINEMAN 1.0 SE 216TH ST RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE INSURANCE CO SAME.
EFFECT
&POLICY#
IN EF 9TOP
ve FE CHARGE to BOTTOM 5 36
LE ALLv YES No CITATION# 4AO078016,4AO078016 NO DRIVER'S LICENSE ON PERSON,
15❑ NDING 8 6
UNIT ' MOTOR PEDAL... ❑ PEDESTRIAN ❑ PROPERTY ❑ DAM THR OLD MET PHONE
16 a i�l VEHICLE CYCLE OWNER YES�/ NO
LAST NAME CLARK FIRST NAME KENDRA MIDDLE M
INITIAL
17❑ STREET ❑', 520 OCCIDENTAL AVE S UNIT 604 CITY' SEATTLE ST WA ZIP 981046830 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED 38
INTERLOCK YES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LICENSE# STATE WA SEX F M D.C.B. 01 16 _ 1987 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CEU6886 TATe WA VIN1t 1C4RJHBG1P8764318
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2023 MAKE JEEP MODEL GRAND STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KENDRA CLARK 520 OCCIDENTAL AVE S UNIT 604 SEATTLE WA 981046830 D:5412212487 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO USAA 02202 32 76GIN I GD
VEwcLE CITATION# CHARGELEGAL25
LY YES N�
❑ s a
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. EE50263
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1333
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 02-06-24 11:15 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 2/14/2024 10:44:49 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 8:28 AM TIME POLICE ARRIVED',8:35 AM
PART I PAGE IT]OF 4�
REPORT NO. EE50263 CASE# 24-1333 OF COLLISION
02/06/24 08:27
OF CbLLI510N
NARRATIVE
wht sedan lane 3 wht 2 stopped
CC
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the 1800 block of
Maple Valley Hwy.
I contacted the driver of unit 2 who told me she was in lane 4 stopped for the traffic light when she
was hit from behind by unit 1. She did not complain of injury and damages did not require a tow
truck.
I contacted the driver of unit 1 verbally ID'd as Heineman, Josiah J 05232004. A WACIC/DOL
showed a picture of unit 1 driver with a clear and valid license. He told me he didnt stop in time and
hit the back of unit 2. He did not really provide any additional information. He was somewhat stand-
offish and was slow to respond. He did not provide any form of ID. He did not complain of injury and
damages did require a tow truck.
I cited unit 1 driver/Heineman ref RCW 46.20.017 Fail to carry ID on person and ref RMC 10-12-25
Driver Inattention 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 2/6/2024
PAGE 3 OF 4
REPORT NO. EE50263 CASE# 24-1333 DATE AND TIME 02/06/24 08:27
OF COLLISION
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PAGE 4 OF 4