HomeMy WebLinkAbout24-3672 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 24-3672 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 04 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 04 - 1-— 2024 1428 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BL
SW SUNSET BLVD
OCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET VV a STEVENS AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2062250957 0 11
30
6� LAST NAME POREE FIRSTNAME ALAYNENA MIDDLE M 1 2 31
INITIAL
STREET ❑ 6800 62ND AVE NE APT 2103 CITY SEATTLE ST WA 2jp, 981155034 z=
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO I INTERLOCK YES NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BHH4717 sTArI WAvIN# 1G8ZS57N98F226492
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 3 2008 STRN AURA DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO ALAYNENAPOREE680062NDAVENEAPT2103 SEATTLE WA 981155034 D:2062250957 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO <53 4
IN EFFECT &POLICY# TOPVEHicLE CHARGE 36
LEGALLvYEs❑NO CITATION# OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2067537564
LAST NAME VA LE MARTINEZ FIRST NAME JOSE MIDDLE q
INITIAL
17❑ STREET ❑ 555 BREMERTON AVE NE APT A 101 CITY RENTON ST WA ZIP 980594730 37
NEW ADDRESS I I I I ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 07 27 1976 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CAZ9710 TAre WA vIN# 4T10E30P67U753656
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2007 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO JOSE VALLE MARTINEZ 555 BREMERTON AVE NE APTA101 RENTON WA 980594730 D:2067537564 VEHICLE NO.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU8PORGY#ECO ST FARM 4848442-A30-47AIN STOP 5
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N J
25 ' a
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. EE69009
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3672
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.
M.LEVERTON 04-05-24 02:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 411712024 2:06:33 PM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED 2:28 Pry TIME POLICE ARRIVED 2:31 PM
PART I PAGE IT]OF 5�
REPORT NO. EE69009 CASE# 24-3672 OF COLLISION
04/04/24 14:28
OF CbLLI510N
NARRATIVE
wht van 3 wht sedan 2 blk sedan 3 all In 3 ped cross brake swerve to left rear
RTF
Within the city of Renton/King/WA I responded to a 3 car blocking crash at the intersection of SW
Sunset Blvd and Stevens Ave SW.
I contacted the driver of unit 3 who told me she was in lane 2 westbound when an unknown
Pedestrian ran out in the middle of the intersection while her light was green. She said he just ran
out, probably to catch a bus. She had to emergency brake to avoid hitting the ped when she was hit
in the back by two other vehicles. She said as soon as the crash took place he ran north up the hill
and disappeared. She did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 2 who said he saw unit 1 brake and swerve to avoid a pedestrian running
across the intersection while his light was green and red for the ped. He said unit 1 blocked his view
as unit 1 swerved and hit unit 3. He said soon as he realized it unit 3 was slowed and he contacted
her from behind. He did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 who told me she thought both her and unit 3 were going to hit the
unknown ped. She swerved and braked but glanced the driver back corner of unit 3 with her front
passenger side. She was obviously shaken and upset. She did not complain of injury and damages
did not require a tow truck.
The Ped was never located and fled the scene on a foot north on Stevens Ave SW.
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 4/5/2024
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EE69009
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-3672
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 5 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 DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO
D:5034811973
0 1 29
LAST NAME LIAO FIRST NAME ZHE MIDDLE N
INITIAL
STREET 30
NEW AnDRFSP' 1929 OLYMPIA CT SE CITY RENTON ST WA ZIP 980583905
6
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv 06 - 08 - 1982
7 ❑ ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BGA4225 [TAT WA VIN# 5FNRL6H97JB017465
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 TRLR TRLR 91 VIN.#. VIN.#.
11 3 5 VEH.YEAR2018 MAKE HOND MODELODYSSEY STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1G P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFOZHE LIAO 1929 OLYMPIA CT SE RENTON W SHADE IN DAMAGED AREA A 980583905 D:5034811973 3 ] 33
12 �
7 j FROM TO
LIABILITY INSURANCE INSURANCE CO SAFECO H2329148 q"i"Olx
IN EFFECT &POLICY#
1 ------- 5 1 34
13 ❑ EL L ❑ ❑ CHARGE 0 BOTTUM
LEGAGALLY YES NO CITATION#
STANDING �} � 7
14 UNIT# 4 VEO IOCRLE ❑ CYCLE ❑ ❑ OWNER
❑ YES�ENOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
❑UNK MIDDLE'. 36
15
LAST NAME FIRST NAME '
INITIAL
2 STREET
16 ❑ ❑; UNK CITY RENTON ST WA ZIP 98057
NEn+AnnRFSS
CDL IGNITION REOUIREE7 IGNITION PRESENT MEDICALTANSPORTED
17 ❑ INTERLOCK YES NO INTERLOCK YEs N. rEs NO ElDRIVER'S STATE SEX M mooD,O _ 37
18 ❑ LICENSE# MMDDYYY
ON DUTY❑ STATUS 3 AIRBAG RESTR, EJECT HELMET INJURY 0 NATURE OF INJURIES 38
USE (CLASS ❑
19 ❑ 39
LICENSE rnr VIN#
PLATE#
20 8 TRAILER I TRAILER ❑ 40
PLATE# STATE PLATE# STATE
21 ❑ TRLR TRLR 41❑
VIN# YIN#i
22 ❑ 42
❑
VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 ❑ REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO '
IN EFFECT &POLICY# i _9_rOP___ g 44
24 1 7 VEHICLE YES❑ N. CITATION# CHARGE 7060TiOM
EGALLY
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.
X LEVERTON 04-05-24 02:41 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
BADGE O#I' APPROVED
126 ORID# 2517 WA0171300 ACOBS 4 PAGE F41 OF❑
3000-345-013(R 11118)
REPORT NO. EE69009 CASE# ' 24-3672 DATE AND TIME 04/04/24 14:28
OF COLLISION
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Sr �
u
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PAGE 5 OF 5