HomeMy WebLinkAbout24-3343 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE65042 170
27
COLLISION REP FIT 1591971
CASE 24-3343 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 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.. 03 - 1-— 2024 0752 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S CARR RD BLOCK NO. e✓ 700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 275 00 FMILES EET ❑ S ❑ W e SMITHERS AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:8052181016 2 01
30
6� LAST NAME MITSUUCHI FIRSTNAME TAYLOR MIDDLE A 1 2 31
INITIAL
STREET 01 7508 3RD AVE NW CITY SEATTLE ST WA 2jp, 981174909 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❑
❑10 9❑ Pi aT�S� BZE3228 sTArI WWAVIN# 19UUA66217A031256 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T �pN��] GOVT.VEHICLE 7 $ 34
13 2 N ACUR TL DAMAGE yES 0NO f �" WkkRS YES : NO
REGISTERED OWNER INFO TAYLOR MITSUUCH775083RD AVE NW SEATTLE WA981174909 D:8052181016 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO PROS 948205283
IN EFFECT &POLICY# 9TOP
❑ LEGALLY CHARGE 1 5 36
15 2 YEs No clTAnoN# 4A0078059 IMPROPER LANE USAGE o Borrob
MOTORUN� ❑ ❑ PRPERTY ❑ DAM / THR OLD M HDOE5 3T 02 VEHICLE ❑ PEDESTRIAN 2
16 a CYCLE OWNER YES No 3433742
LAST NAME LOPEZ FIRST NAME SAMANTHA MIDDLE L
INITIAL
17❑ STREET ❑', 717 STATE AVE N APT C3 CITY KENT ST WA ZIP 98031 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs❑No� YES❑No❑ 11
19� DRIVER'S STATE WA ]SEX IF D.C.B. O6 27 1999 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 BUY8374 TAre I WA VIN1 4T1BF1FK2FU065712
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2015 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO SAMANTHA LOPEZ 717 STATE AVE N APT C3 KENT WA 98031 D:2533433742 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
ve ALE YES N� CITATION# 4AO078060,4AO078060,4AO078060 CHARGE NO VALID OPER LICENSE WITH VALID Io ao-r-roM
VE"�Lr
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777PNCY
26
M.LEVERTON 2517 0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE65042
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3343
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 DATE
C.JACOBS 1953 4/3/2024 5:51:53 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 7:53 AM TIME POLICE ARRIVED',7:59 AM
PART I PAGE IT]OF 4�
REPORT NO. EE65042 CASE# 24-3343 OF COLLISION
03/28/24 07:52
OF CbLLI510N
NARRATIVE
unit 2 slv lane 2 blue unit 1 speed lane change
CC CC
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash near the 700 block of S
Carr Rd. Both eastbound lanes were blocked.
I contacted the driver of unit 1 ID'd by picture WADL, who told me she was in lane 1 eastbound and
wanted to make a left turn at Smithers Ave S. She said she sped up and made a late lane change
cutting off unit 2, making contact with her car and causing undrivable damage to both. She did not
complain of injury and damages required a tow truck.
I contacted the driver of unit 2 ID'd by cell phone passport picture and later by MDC DOL photo. She
told me she was in lane 2 westbound and thought unit 1 was trying to make a U-turn in front of her.
She said she was just struck by unit 1. Unit 2 told me she did not have a drivers license this state or
another, did not have insurance for her car as she could not afford it. Also her vehicle tabs were
expired by two years. She did not complain of injury but said she was 17-18 weeks pregnant. I had
Renton Fire respond for a check on unit 2. Her vehicle was towed for damages.
A WACIC/DOL check by Dispatch and by MDC revealed unit 2 driver was eligible but not licensed to
drive. She has a history of NVOL and no insurance citations. A WACIC/DOL check via Dispatch and
MDC on unit 2 vehicle revealed her tabs had expired 06-27-2022, displayed 6-2022.
1 cited unit 1 driver ref RCW 46.61.140 Improper lane change/lane use 2 car crash via complaint.
I cited unit 2 driver ref RCW 46.20.015 Driving with No Valid Operators License with ID (NVOL 2nd)
ref RCW 46.30.020 No Valid Proof of Insurance and ref RCW 46.16A.020 Expired Tabs more than 2
months 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 3/28/2024
PAGE 3 OF 4
REPORT NO. EE65042 CASE# 24-3343 DATE AND TIME 03/28/24 07:52
OF COLLISION
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PAGE 4 OF 4