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Home My WebLink About24-3009 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 ❑ ❑ FIRE ❑ CASE# 24-3009 z 0 7 INTERSTATE CITY STREET ✓ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3❑HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cawsloN 03 - 1-- 2024 0812 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ MAPLE VALLEY HWY BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e BLA/NEAVE NE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2064843739 0 7 30 6� LAST NAME JENDRUH FIRSTNAME NERMINA MIDDLE N 1 1 2 31 INITIAL STREET ❑ 17693 134TH LN SE CITY RENTON ST WA ZIP 980586817 2 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 2❑ 3 10 9❑ P1 aT�S� AJY3914 sTArI WAvIN# JF1 GJAA61 DH009257 TRAILER STATE TRAILER STATE 11 4 0 PLATE# PLATE# ROM ro TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34 13 2013 SUBA IMPREZ DAMAGE YES NO ✓ YES[:] No✓ REGISTERED OWNER INFO NERMINA JENDRUH 17693134TH LN SE RENTON WA 980586817 D:2064843739 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE z INSURANCE CO TRAVELERS 603450115 203 1 4 LI EFFECT I POLICY# TOPVEHICLE CHARGE 36 LEGALLv res❑NO❑ CITATION# <1�3 OTTOM 15❑ STAIN,DIING 7 6 UNIT U2 VEHIMOTCCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES [:]I DYES✓ NO OLD MET PHONE 16 a LAST NAME GARANA FIRST NAME JASMINE MIDDLE I E INITIAL 17❑ STREET ❑', 19237 136TH PL SE CITY' RENTON ST WA ZIP 980587736 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑ 19 DRIVER'S STATE WA ]SEX IF D.O.B. 03 _ 27 2003 39 LICENSE# MMDDYY HELMET I {NJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21❑ LICENSE BKZ1775 TArE WA VIN1i 1C3CDFBA6DD181716 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. YEAR 2013 MAKE DODG MODEL DART STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 VEH L4❑ DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO GEORGE GARANA 19237136THPL SE RENTON WA 98058 VEHICLE NO.2 SHADEDAMAGEbAREA s Cd LIABILITY INSURANCE INSU POLICY#E CO SAME.IN 9TOP VE""LE CITATION# CHARGE YES 25 N to BOTTOM LEGALLY u ❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 M.LEVERTON 2517 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE65036 COLLISION REPORT III III III III III 111 1591972 CASE# 24-3009 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 03-28-24 11:08 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 4/3/2024 5:49:25 PM BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 8:92 AM TIME POLICE ARRIVED',8:16 AM PART I PAGE IT]0F 5� REPORT NO. EE65036 CASE# 24-3009 OF COLLISION 03/20/24 08:12 OF CbLLI510N NARRATIVE maroon/1 whtt 2 blue/3 lane 2 west RTF Within the city limits of Renton/King/WA I responded to a 3 car blocking crash near the 2200 block of Maple Valley Hwy. When I arrived one car was in lane two west bound, one car was in a near by parking lot and one car left the scene. I pushed unit 2 out of the roadway into the parking lot near unit 1. I contacted the driver of unit 2 who told me she had just stopped when she was contacted by unit 1 from the back. Damage was minor, but did require a tow truck, most likely from the safety fuel shut off impact switch equiped on some vehicles. She did not complain of injury. She said she slowly rolled into a car stopped in front of her. She told me unit 3 had little to no damage. The driver gave her a name, phone number and the word Pemco and left the area. I contacted the driver of unit 1 who told me she isn't sure how she even made contact with unit 1. She said she slowly rolled into unit 2. Damages to her car were minor and she did not require a tow truck. She did not complain of injury She told me unit 2 contacted unit 3 but damages were very minor if any and unit 3, provided a name and number and left the scene. I tried several times to contact unit 3 by phone-text and voice mail. I was not able to get any additional infirmation from unit 3. 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 3/28/2024 PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EE655036 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-3009 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ 0 7 29 LAST NAME : THEROU FIRST NAME TRISTA MIDDLE INITIAL STREET 30 NEW AnDRFS CITY RENTON ST ZIP 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YES[:]NO zERLOCK YES E]Na� YEs N DRIVER'S STATE I SEX U M��DYSYv' —� 2 LICENSE 7 ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET INJURY 0 NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWE E T SABLIN TOWED BY anvi vEH1C P FROM TO DAMAGE YES NO ✓ YES NO ✓ REGISTERED OWNER INFO.TRISTA THEROU UNK RENTONWA98057 J 9 33 12 � SHADE IN DAMAGED AREA 34 FROM TO LIABILITY INSURANCE INSURANCE CO IN EFFECT &POLICY# tGQO VEHICLE 34 13LEGALLY YESZ NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 35 15 LAST NAME FIRST NAME : INITIAL MIDDLE ❑ STREET 16 NEn+AnnRFsFl .�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 03-28-24 11:08 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED BADGE O#II APPROVED /325 ORID# 2517 WA0171300 ACOBS 43/2 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EE65036 CASE# 24-3009 DATE AND TIME 03/20/24 08:12 OF COLLISION a lF )) t 8 PAGE 5 OF 5