HomeMy WebLinkAbout24-4481 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-4481 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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 0719 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S GRADY WAY BLOCK NO. e✓ ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ FEET❑ e S ❑ VV a RAlINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2063545379 0 6 30
6� LAST NAME SULLIVAN FIRSTNAME THOMAS MIDDLE M 1 2 31
INITIAL
STREET ❑ 23330 124TH AVE SE CITY KENT ST WA ZIP 980313680 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO I INTERLOCK YES NO YES R NO
8❑ LRIIVERS STATE WA SEX'M MM DAY' 04 1— 23 — 1960 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 1❑ P1 ATE 14 AQS3197 STATE WA u N#' 3FA6POH75ER284326
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2 2014 FORD FUSION DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO THOMAS SULLNAN 13330124TH AVE SE KENT WA 980313680 D:2063545379 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO GEICO 4194-61.34.95 4
LI EFFECT I POLICY# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254290482
16 a
LAST NAME NEARY FIRST NAME EDWARD MIDDLE I F
INITIAL
17❑ STREET ❑', 16318 131ST AVE SE CITY' RENTON ST WA ZIP 980585512 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 12 _ 07 1963 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE B30050V TATe I WA vIN1t 1FTFW1EF6CKD10996
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2012 MAKE FORD MODEL F150 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO EDWARD NEARY16318131STAVESE RENTON WA 980585512 D:4254290482 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSURANCE
#E CO TRAVELERS 996129184 203 1IN IU�'E""LE
TOP
❑ ,J� CITATION# CHARGE TTOMLGALYYES N`L J25 '
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. EE79885
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4481
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 FIRST 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'
outside Itl blk sedan/1 blue trk for yellow rear
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash at the intersection of S Grady
Way and Rainier Ave S.
I contacted the driver of unit 2 who told me he made a sudden stop for the yellow light before making
his turn from Grady onto SIB 167/405 when he was hit from behind by unit 1. He did not complain of
injury and damages did not require a tow truck.
I contacted the driver of unit 1 who told me he was proceeding forward outside left turn lane from
Grady to SB SR167 when unit 2 stopped suddenly for a yellow. Unit 1 told me he noticed unit 2
stopping about the same time he was making a mirror check and contacted unit 2. He 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 04/25/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 04-25-24 01:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 5/23/2024 5:51:17 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 7:20 AM TIME POLICE ARRIVED',7:Y7 AM
PART I PAGE IT]OF
REPORT NO. EE79885 CASE# 24-4481 DATE AND TIME 04/25/24 07:19
OF COLLISION
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