HomeMy WebLinkAbout24-3336 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-3336 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 7 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.. 03 - 1-- 2024 1805 17 =-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e✓ 500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ V\a LOGAN AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4253467684 0 81
30
6� LAST NAME CHRISTIE FIRSTNAME HARMONIE MIDDLE A 1 2 31
INITIAL
STREET 013719MEADOWAVEN CITY RENTON ST WA 2jp, 980561551 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YESO NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEXI F MM DAY' 12 1— 17 — 1996 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CHM6572 sTArI WAurN# 4S46TACC8t 3121417
TRAILER STATE TRAILER STATE
11 0 0 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 TOWED BY GOVT.VEHICLE g 9 34
13❑$ ZO2O SUBA OUTBA SV DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO DAMES BUYERS 1135 LATTIMORE RD FERNDALE INA 98248 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO ALLSTATE 820004186 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ LEGALLY STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ,/ D:2069196132
LAST NAME GREILING FIRST NAME RODNEY MIDDLE M
INITIAL
17❑ STREET �', 27908 123RD AVE CITY KENT ST WA ZIP 98030 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE I CFD0923 TAre WA vIN# 1C4PJMLB5KD136801
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE JEEP MODEL CHEROK STYLE SI/ VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JANET GREILING 27908123RD PL SE KENT WA 98030 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#ECO USAA CASUALTY INSURANCE COMPANY 00442 70 46C IGD
IN EFFECT
VE""LE CITATION# CHARGE LEGAL
25
LY YES Nu
❑ s a
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE65039
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3336
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
PM 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.
MATTHEW NUGENT 03-28-24 03:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 4/3/2024 5:48:00 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 8:09 Pry TIME POLICE ARRIVED',6:14 PM
PART I PAGE IT]OF 4�
REPORT NO. EE65039 CASE# 24-3336 OF COLLISION
03/27/24 18:05
OF CbLLI510N
NARRATIVE
On 03/27/2024 at approximately 1805 hours, I was dispatched to a non-injury and non-blocking two-
vehicle collision at the intersection of Airport Way and Logan Ave S, within the City Limits of Renton,
County of King, State of Washington.
Upon arrival, I contacted the involved parties and confirmed no injuries had occurred requiring
immediate medical response at the time of report. There, I collected the involved parties driving
documents and their independent recollection of events leading up to the collision.
The driver of Unit#1 said she was traveling eastbound on Airport Way between Shattuck Ave and
Logan Ave. The driver of Unit#1 stated she was traveling in her lane when Unit#2 abruptly moved in
front of her and then had to step on their brakes for a red light. The driver of Unit#1 stated that the
driver of Unit#2 moved in front of her quicker than she was expecting and attempted to stop her
vehicle in time but was unable to and subsequently collided with the rear of Unit#2 causing moderate
damage to the hood of Unit#1.
The driver of Unit#2 said he was the sole occupant of his vehicle and also traveling eastbound on
Airport Way between Shattuck Ave and Logan Ave. The driver of Unit#2 stated he was intending to
change lanes and continue heading northbound on Logan Ave. While Unit#2 was slowing down to
prepare for the red light, Unit#1 collided with the rear of Unit#2 causing minimal damage to the rear
of Unit#2.
1 recommended that both involved parties contact their respective insurance companies.
Unit#1 was able to be driven away without further incident. Unit#2 also drove away without further
incident. No citation was given to either party. An exchange of information was provided to all
involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer N. Swan #12965 2:27 PM on 03/28/2024 in Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EE65039 CASE# ' 24-3336 DATE AND TIME 03/27/24 18:05
OF COLLISION
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