HomeMy WebLinkAbout24-1597 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-1597 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 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 1346 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 144
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1751. 00 FEET e S MILES N B W e S 3RD ST
1 2 29
UNIT MOTOORVECL Z CYCLE ElDDAMYESA✓NOESHOLDMET PHONE Q 11
30
6� LAST NAME SIMON FIRSTNAME TERANCE MIDDLE A 1 1 2 31
INITIAL
STREET El 300 VUEMONT PL NE APT A101 CITY RENTON ST WA 2jp, 980564505 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
LRIIVER # STATE WA SEX'M MI MIT Y
8❑ ' 08 — 20 — 1962 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
LICENSE CHT2370 sTArI WAurN# WBA6D6C53GG387960
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR N MAKE BMW MODEL 650 STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 DAMAGE YES NO ✓ YES[:] No
✓
REGISTERED OWNER INFO TERRANCE SIMON 300 VUEMONTPL NEAPTA101 RENTON WA 98056 D:3139782542 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
IN EFFECT &POLICY#
14 LIABILITY INSURANCE INSURANCE CO SAME.
T 9TOP
VE—LE CHARGE 5 36
ECALLv ❑NO❑ CITATION# 1 o BOTTOM
15❑ L STANDING YES 8 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNFRRTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME ENGSTROM FIRST NAME DANIEL MIDDLE W
INITIAL
17❑ STREET ❑', 21424 99TH AVE S CITY KENT ST WA ZIP 980312004 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❑ 11
19 DRIVER'S STATE WA SEX M D.C... 11 � 1973 13 _ El 39
LICENSE# MMDDYY
WELMET INJURY 7 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE CLASS LEFT HAND/THUMB ❑
21❑ LICENSE I CKS0634 TAre WA VIN# 4T1L31AK4LU017659
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES✓ NO GENE MEYER YES NO✓
REGISTERED OWNER INFO DANIEL ENGSTROM 2142499TH AVE S KENT WA 98031 D:2537973356 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' e
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. EE54009
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1597
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'
wht sedan crossing wendys to Walgreen's blue lane 1
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash near the 144 block of Rainer
Ave S.
I contacted the driver of unit 2 who told me he was southbound lane 1 on Rainer Ave S when
suddenly unit 1 was longways across his lane where they contacted. He was checked by Renton Fire
for airbag abrasion. His vehicle was towed for damages.
I contacted unit 1 who told me he was crossing Rainier Ave S from Wendy's towards Walgreen's. He
told me all traffic was stopped and he was waved through towards Walgreen's. He told me he did not
see any other cars and it appeared clear in both directions and so he proceeded. However, he did
not see unit 2. He was checked by Renton Fire and chose to have his car towed, because he was
headed to the doctor for additional checks.
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 2/14/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-14-24 08:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 2/26/2024 5:04:31 PM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED 1:46 PM TIME POLICE ARRIVED'1:51 PM
PART I PAGE IT]OF 3�
REPORT NO. EE54009 CASE# ' 24-1597 DATE AND TIME 02/13/24 13:46
OF COLLISION
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