HomeMy WebLinkAbout24-3718 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE69015 170
27
COLLISION REP FIT 1591971
CASE 24-3718 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 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'. 04 - 1-- 2024 1442 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 3RD ST BLOCK e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FMILES EET e S ❑ W e SHATTUCKAVES
0 4 29
MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
,/No D:4257491414 0 11
30
6� LAST NAME HERMAN FIRSTNAME BAILEY MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 2101 SW SUNSET BLVD APT G402 CITY RENTON ST WA Zjp, 980576132 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
LICENSE CEV6549 sTArI WAurN# JHMGE88469S033283
10 F91 PI ATE#
TRAILER STATE TRAILED STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 7 1 33
12 2 5 VIN#' VIN#'
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 1 2009 HOND FIT DAMAGE YES NO ✓ YES❑ NO✓
REGISTERED OWNER INFO BAILEY HERMAN 2101 SW SUNSET BLVD APT G402 RENTON WA 980576132 D:4257491414 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 966934353 3 4
IN EFFECT &POLICY# 9TOP
VE—L' CHARGE 1 5 36
LEGALLY
ve6 NO CITATION# 10 BOTTOM
15❑ .......E 6
UNIT VEHIMOTCLE CYCLE ❑ PEDESTRIAN ❑ OWN RRTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME PHAENGPHA FIRST NAME NARASACK MIDDLE I N
INITIAL
17❑ STREET ❑', 618 W PIONEER APT B CITY' PUYALLUP ST WA ZIP 983715364 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALt-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NoF YES t l NO❑
19[—] D IVEW #
I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CGT3819 TAre WA VIN# 1GYS48EF1CR124679
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2012 MAKE CADS MODEL ESCALAD STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO NARASACK PHAENGPHA 618 W PIONEER APT PUYALLUP WA 983715364 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#E CO FARMERS 539811535IN 1GQI
V'""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
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. EE69015
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3718
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 03:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 4/16/2024 2:20:50 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 2:43 PM TIME POLICE ARRIVED',2:47 PM
PART I PAGE IT]OF 4�
REPORT NO. EE69015 CASE# 24-3718 OF COLLISION
04/05/24 14:42
OF CbLLI510N
NARRATIVE
blk/2 lane 2 purple 1 lane right left turn to safeway
RTF
Within the city limits of Renton/King/Wa I responded to the 200 block of S 3rd St for a 2 car blocking
crash.
I contacted the driver of unit 2 who told me he was east bound lane 2 S 3rd St when unit 1 hit the side
of his car. It pushed his running board into the rear tire and he was unable to move his vehicle out of
the roadway. He did not complain of injury.
I contacted the driver of unit 1 who told me she thought she was on a 2 way and from lane 1 made a
left turn to Safeway but unit 2 was lawful in lane two when she contacted his vehicle. She did not
complain of injury and damages 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 4/5/2024
PAGE 3 OF 4
REPORT NO. EE69015 CASE# ' 24-3718 DATE AND TIME 04/05/24 14:42
OF COLLISION
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