HomeMy WebLinkAbout24-1711 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 24-1711 z
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 2 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 1359 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE EXT
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e TAYLOR AVE NW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2532173553 0 11
30
6 LAST NAME ROMERO RUIZ FIRST NAME LIL/A MIDDLE F 1 2 31
INITIAL
STREET ❑ 12842 SE 272ND PL BLDG 2 CITY KENT ST WA ZIP 980308944 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8 LRIIVER #
-, [NATURE OF INJURIES
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H U SE CLASS 7 I CHEST STOMACH z❑
3
10[1P1 ATNES# CEP3262 sTAr WAu N# JTDP4MCE6N3512367
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 1 $ 34
13 2 2022 TOYT COROL DAMAGE YES ✓ NO YES[:]YES❑ No✓
REGISTERED OWNER INFO OB RENTON 11C 150S1ff 7TH ST RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE 820 589 134 3 4
IN EFFECT &POLICY# 9TOP
❑ VEwcLE CHARGE 5 36
15 2 LEGAALLL'Y YES No CITATION# 4A0078036 FAIL TO OBEY TRAFFIC CONTROL o aorrob
UNIT VE IMOTOOR CYCLE ❑ PEDESTRIAN ❑ OWN RRTY ❑ DYES✓ NO�TFIRrIOLDMET PHONE
16 a
LAST NAME JACOBS FIRST NAME CARLA MIDDLE IR
INITIAL
17❑ STREET ❑', 8527 S 115TH PL CITY' SEATTLE ST WA ZIP 981783921 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER #
❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS UNK
21❑ LICENSE I CBL7899 TArE WA vIN# ML32AUHJ5NH001487
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE MITS MODEL MIRAGE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO CARLA JACOBS 8527S 115THPL SEATTLEWA98178 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE52799
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1711
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 FIRST 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'
blue eb In 2/red lite red coupe sb on green
cc
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash with injury at the
intersection of Renton Ave Ext at Taylor Ave NW.
I contacted the driver of unit 2 who told me she was south on Taylor crossing the intersection on her
solid green light when she was hit by unit 1. She was checked and released on scene by Renton
Fire. Her car was towed for damages.
I contacted the driver of unit 1 ID'd by her picture WADL. She did not provide much explantation how
the crash took place. She pointed and said she was going this was and crashed with the red car.
Unit 2 was eastbound in lane 2 and FTCWTCD-Red Light crashing with unit 2. She was treated and
transported to VMC-ER for additional checks. Damages required a tow truck.
I cited unit 2 ref RCW 46.61.055 FTCWTCD 2 car injury 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 2/16/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-16-24 04:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 2/22/2024 8:54:41 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; ?:59 Pry TIME POLICE ARRIVED:2:05 PM
PART I PAGE IT]OF
REPORT NO. EE52799 CASE# ' 24-1711 DATE AND TIME 02/16/24 13:59
OF COLLISION
drat
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