HomeMy WebLinkAbout24-4056 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-4056 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 1134 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
ROUSER WAYS BLOCK NO. e✓ 200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e MI!!AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2063028302 0 11
30
6❑ LAST NAME WILLIAMSON FIRSTNAME ALYSHA MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 1525 S 6TH ST TON WA
NEW ADDRESS ST zIP', 96057 2 CITY REN
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 06 1- 22 - 1987 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CHR0634 sTAT� WA vIN# JTMRFREV9DD000740
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2013 TOYT RAV4 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO ALYSHA WILLIAMSON 1525 S 6TH ST RENTON WA 98057 D:2063028302 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 6121012816
IN EFFECT &POLICY# 9TOP
VEHICLe
15❑ EC 5 36
LALLv YES❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2068561003
LAST NAME DIAZ LEPE FIRST NAME BLANCA MIDDLE E
INITIAL
17 STREET❑ NEW ADORE55❑' 3815 NE 4TH ST#C76 CITY RENTON ST WA ZIP 98056 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NO❑
19 DRIVER'S STATE WA ]SEX IF D.C.B. O6 _ 26 _ 1978 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑LICENSE I 21❑ PLATE# CKS8203 TATE 41
WA VIN# 2T3BFREV8FW351887 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2015 MAKE TOY7- MODEL RAV4 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO BLANCA DIAZ LEPE 3815 NE 4TH ST RENTON WA 98056 D:2068561003 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE� &POINSURGY#E CO STATE FARM 4294815-1328-47CIN 1 5—e E ❑ ,J� CITATION# CHARGE
25 UQ,
LEGALLY YES N J
=AS
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 GOODWIN 12884 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE68253
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4056
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.
NICHOLAS GOODWIN 04-13-24 05:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 4/15/2024 11:45:46 AM
BADGE OR ID# 12884 ORI#' WA0171300 TIME POLICE DISPATCHED! 11:34 AM TIME POLICE ARRIVED',11:47 AM
PART Ei PAGE IT]OF 4�
REPORT NO. EE68253 CASE# 24-4056 OF COLLISION
04/13/24 11:34
OF CbLLI510N
NARRATIVE
24-4056
Unless otherwise noted, the following took place within the city limits of Renton, Count of King, WA.
On 04/13/2024 at approximately 1140 hours, I was dispatched to a non-injury, non-blocking motor
vehicle collision and the vehicles were pulled off the roadway and located at 200 Mill Ave S. Dispatch
advised the collision occurred at the intersection of Houser Way S and Mill Ave S.
Upon arrival I identified Unit 1 as silver 2013 Toyota Rav4 bearing license plate WA/CHR0634. Unit 1
sustained moderate damage to the front driver's side corner but appeared drivable.
I identified the driver of Unit 1 via her WA DL, as Alysha D. Williamson (06/22/1987). Alysha stated
she was not injured and did not need to be evaluated. When I asked what happened, Alysha told me
the following:
She was waiting at the intersection of Mill Ave S and Houser Way S. She was on Mill Ave S, waiting
to proceed westbound on Mill Ave S. Alysha told me the light turned green and she proceeded
through the intersection. As she pulled into the intersection, she collided with Unit 2. Alysha advised
she did not see Unit 2, or any traffic driving through the intersection.
I identified Unit 2 as a blue 2015 Toyota Rav4 bearing license plate WA/CKS8203. Unit 2 sustained
moderate damage to the passenger side of the vehicle; from the front passenger side fender to the
rear passenger side fender.
I identified the driver of Unit 2 via her WA DL, as Blanca Diaz Lepe (06/26/1978). Blanca stated she
was not injured and did not need to be evaluated. When I asked what happened, Blanca told me the
following:
She was facing northbound at the intersection of Houser Way S and Mill Ave S. Blanca was
proceeding through the intersection, heading northbound, and was struck by another vehicle on the
passenger side. Blanca advised she did not see Unit 1 pulling into the intersection.
I provided both parties a case number, as well as the exchange of information. Neither vehicle
needed a tow. Neither party received a citation.
I cleared the scene. This concludes my report.
PAGE 3 OF 4
REPORT NO. EE68253 CASE# ' 24-4056 DATE AND TIME 04/13/24 11:34
OF COLLISION
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PAGE 4 OF 4