The URL can be used to link to this page

Home My WebLink About24-4366 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-4366 z INTERSTATE ❑ CITY STREET ❑ FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS OS STRUCK' BUILDING 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 2308 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SE PETROVITSKY RD BLOCK NO. e✓ 11900 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 100 00 FEET MILES e S B W e 119TH PL SE 0 1 29 UNIT 01 VEHICLE MOTZ PEDAL-ORCYCLE ElDESA✓NHORESHOLDMET PHONE 1 4 30 6❑ LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31 INITIAL STREET ❑ CITY RENTON ST ZIP 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 :NTERLOCKYEs NO INTERLOCK YES NO YES No 8 DRIVER'S STATE SEX U D.QB 32 ❑ :LICENSE# MMDDYY —= 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑ 3 LICENSE sTAT1 urN#' 10❑ PI ATE 14 TRAILER TRAILER STATE STATE 11 0 0 PLATE# PLATE# FROM ro TRLR. TRLR m 33 12 0 0 VIN#' VIN#' >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE m 13❑ DODG RAM DAMAGE YES NO YES[:] NO✓ 34 REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEF" CHARGE 1 5 36 LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STAIN,DIING 8 7 6 UNIT U2 VEHICCMOTOLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES [:]I DYES NO THR OLD MET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY RENTON ST ZIP $ 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PRESENT tSENT MEDICAL—T�RANSPORTED 38 INTERLOCK YEs❑NoR INTERLOCK YES It1 I NOF YES l NO❑ 19 LLIICENS RIVER# STATE I SEX U MMDDYY —=_ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT '1 USE 9 CLASS 0 ❑ ❑ILICENSE 21❑ PLA E# AUL1591 TATe 41 WA vIN# 1C4NJRBB8FD308122 4 42 22 [TRAILER TILER ❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN It 'IN#. VEH YEAR 2015 MAKE JEEP MODEL PATRIOT STYLE UT VEHICLE TOWED TO BLIN TOWEDeY GOV HI �44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO MATTHEW GUY 11909 SE 175TH ST RENTON WA 98058 D:4253063167 VEHICLE NO.2 SHADE IN DAGED AREA 2 4 LIABILITY INSURANCE INSURANCE #E CO USAA 021575196G IN 1 VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM LEGALLY YES N`LJ 25 s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEITH PETTY 1 1 12809 WA0171300 PAGE 01 OF PART A 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE82236 COLLISION REPORT III III III III III 111 1591972 CASE# 24-4366 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. KEITH PETTY 04-22-24 01:28 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 513112024 4:22:46 PM BADGE OR ID# 12809 ORI# WA0171300 TIME POLICE DISPATCHED! 11:11 PM TIME POLICE ARRIVED]11:15 PM PART I PAGE IT]OF DATE AND REPORT NO. EE82236 CASE# 24-4366 OFCOLISION 04/21/2423:08 OF COLLISION NARRATIVE Case #24-4366 An unknown Hispanic male, driving a Red Dodge Ram pickup truck (Unit 1) heading south through the Gramercy parking lot outside of building A collided with the carport support post. The collision caused the roof of the carport to fall onto a: 2015 Jeep Patriot (AUL1591/WA) VIN/1C4NJRBB8FD308122 (Unit2) Registered to Matthew Guy (DOB 06/09/1982). A 2014 Kia Rio (CSV9066/AR) VIN/KNADM4A31 E6398360 (Unit3) registered to Miali L Burton (DOB 11/01/1998) A 2007 XVV Motorcycle (X62LB/UT) Vin/JYAVP21 E67AO05100 (Unit 4) registered to Justin Roylance. RRFA responded to the scene and took control of securing the collapsed carport roof. "I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct to the best of my knowledge. Electronically signed: K.Petty, Date: 05/05/24t approximately 1941 hours Place: Renton, King County, WA PAGE 3 OF 6 SUPPLEMENTAL REPORT NO. EE82236 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-4366 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 1 8 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY WN�TY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES� IN 2 2 29 LAST NAME : UNKNOWN FIRST NAME MIDDLE INITIAL 1 4 30 ❑ STREET CITY ST ZIP NEW AnDRFsP' RENTON 6 CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES❑N0� YEs N DRIVER'S STATE I SEX U M��DYSYv' —� 2 LICENSE 7 ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES F� USE CLASS 8 ❑ I.. 1 32 LICENSE CSV9066 TAr AZ VIN# KNADM4A31E6398360 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 O O VEH.YEAR MAKE MODEL STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vEH1C P FROM TO 2014 K/A RIO 4D DAMAGE YES 'E YES NO REGISTERED OWNER INFOMIALI BURTON 11909 SE PETROVITSKY RD RENTON WA 98058 D:7194009215 m 33 12 � SHADE IN DAMAGED AREA 3 4 FROM TO LIABILITY INSURANCE[] INSURANCE CO IN EFFECT &POLICY# t 9 1"01? VEHICLE I o BOrroM 34 13 ❑ LEGALLY YES❑ NO❑ CITATION# CHARGE STANDING } 6'& 14 ❑ UNIT# 4 VEO IOCRLE O : CYCLE � OWNER YES AGE NOHRE3/HOLD MET PHONE ❑ 35 PEDESTRIAN 36 15 ❑ UNKNOWN MIDDLE LAST NAME FIRST NAME INITIAL 16 ❑ STREET CITY RENTON ST ZIP N�n+AnntxFSS CDL IGNITION REtIUiREE7 IGNITION PRESENT MEDICALTANSPORTED 17 ❑ INTERLOCK YES NO INTERLOCK YES N. rES NO ❑ DRIVER'S STATE SEX U D.O.B 5 37 18 ❑ LICENSE# MMDDYYY — ON DUTY STATUS AIRBAG 9 RESTR, 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES 38 USE CLASS 19 ❑ LICENSE 39 X62LB TAT UT v+N# JYAVP21 E67AO05100 PLATE# 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ [441 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE MODEL STYLE I VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE Q DAMAGE YES NO YES NO 23 REGISTERED OWNER INEOJUSTIN ROYLANCE 11921 SE 175TH ST RENTONWA 98058 SHADE IN DAMAGED 3 a 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VEHICLE EFFECT &POLICY# i 970P - 4 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LeGALLv E:l 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. KEITH PETTY 04-22-24 01:28 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12809 O#IL WA0171300 JOHNSON 5131/2024 PAGE 4 OF 6 3000-345-013 IR IIIIB, SUPPLEMENTAL REPORT NO. EE82236 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-4366 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- �`"'j PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 5 VEHICLE I_J CYCLE u PEDESTRIAN � OWNER � YEs� NO D:4253097710 MIDDLE 29 LAST NAME t;RAMERCYAPRTMENTS FIRST NAME INITIAL STREET 30 ❑ NEW AnDRFSP' 17425 120TH LN SE CITY RENTON ST WA ZIP 98058 6 CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES❑N0� vES N DRIVER'S STATE I SEX U M��DYSYv' -� 2 LICENSE 7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE GLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIC P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NEW AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiREE7 IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN 39 LICENSE # PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 a 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv 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. KEITH PETTY 04-22-24 01:28 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OR ID# 12809 O#IL WA0171300 JOHNSON 5131/2024 PAGE 5 OF 6 3000-345-013 IR 11t18) REPORT NO. EE82236 CASE# 24-4366 DATE AND TIME 04/21/24 23:08 OF COLLISION F 1 t x � Say? 1 S 1�f t t t u'# , t t t.; b xv1 PAGE 6 OF 6