HomeMy WebLinkAbout24-2848 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE62771 170
27
COLLISION REP FIT 1591971
SASE 24-2848 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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#
cawsloN 03 - 1-- 2024 1453 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
S 7TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ VV a RAINIER AVE S
0 3 29
UNIT MOTOOR � CYDDAL ❑ DYESA✓NOESHOLDMET PHONE O 1 30
6� LAST NAME DO FIRSTNAME TRI MIDDLE M 1 2 31
INITIAL
STREET ❑ 23929 139TH PL SE CITY KENT ST WA 2jp, 980423845 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 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ PI ATE 027YWX sTAT� WA urN#' 4T18K46K59U097927
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# IR.. To
TRLR. TRLR 7 5 33
12 3 0 VIN#' VIN#
>;. FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2009 TOYT CAMRY DAMAGE YES NO ✓ YES[:] No
✓
REGISTERED OWNER INFO TRI DO 23921139TH PL SE KENT WA 98042 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
vE—LE CHARGE 5 36
LEGALLY, YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN,"' 8 6
UNIT 02 VEHICCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
[:]I DYES✓ NO OLD MET PHONE
16 a
LAST NAME JIMENEZ FIRST NAME PEDRO MIDDLE
INITIAL
17❑ STREET ❑', 23664 129TH AVE SE CITY KENT ST WA ZIP 98031 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 D IVEW #
❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS BACK
21❑ LICENSE 478TPT TATE WA VIN1 JTLKT324050211924
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2005 MAKE TOYT MODEL SCIXBS(N STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO PEDRO JIMENEZ 23664129TH AVE SE KENT WA 98031 D:2062287396 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO PEMCO CA 0758026IN IUQI
'E""LE ❑ ,J� CITATION# CHARGELGALYYES N`L J25
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. EE62771
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2848
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'
blk sedan/1 rt maroon sqr/2 forward
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash at SS 7th St at Rainier Ave S.
I contacted the driver of unit 2 who told me he was eastbound lane 1 on his green light when he was
hit on the side by unit 1. He did not complain of injury and damages were minor did not require a tow
truck.
I contacted the driver of unit 1 who was in lane 2 eastbound and needed to go right/south on Rainier
Ave S and changed lanes into the side of unit 2. He did not complain of injury and damages were
minor and did not require a tow truck.
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 3/19/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-19-24 11:44 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 3/26/2024 2:10:31 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! Y:57 Pry TIME POLICE ARRIVED',2:57 PM
PART I PAGE IT]OF
REPORT NO. EE62771 CASE# ' 24-2848 DATE AND TIME 03/15/24 14:53
OF COLLISION
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