HomeMy WebLinkAbout24-4499 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-4499 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 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 1427 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
HOQUTAMAVENE BLOCK MILEPOST ST e✓ 1200
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 500 00 FMILES NEET ❑ S ❑B E ❑ SUNSET BLVD NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064130040 0 6 30
6� LAST NAME LUCAS FIRSTNAME AMADEO MIDDLE Y 1 1 2 31
INITIAL
STREET ❑, 4618 NE 23RD ST CITY RENTON ST WA 2jp, 980593643 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
❑10 9❑ P1 aT�S� CAR8654 sTArI WWAvIN# JM3ER26M3C0415090 3
TRAILER STATE TRAICEia STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 ZO12 MAID CX-7 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO LORENZO GUEXTZALAM 4618 NE23RD ST RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VE—LL CHARGE IOR TTOM 5 36
LEGALLY YES No CITATION# 4A0361491,4A0361491 FOLLOW VEHICLE TOO CLOSELY,OP
15❑ STANDING 7 6
1,1 MOTOR PEDAL-: PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑ ❑ PEDESTRIAN ❑ ❑
VEHICLE CYCLE OWNER YES NO �/
16 a
LAST NAME ANDERSON FIRST NAME NATALIE MIDDLE I,I
INITIAL
17❑ STREET ❑', 12204 SE 67TH PL CITY BELLEVUE ST WA ZIP 980064417 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs❑NOF YES
❑No❑
19 DRIVER'S STATE WA SEX F D.C... 05 _ 27 2007 El 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I TEMP TAre WA vIN1 1FMCU9J94FUC37087
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE FORD MODEL ESCAPE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JENNIFER ANDERSON 12204 SE 67TH PL BELLEVUE WA 980064417 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO TRAVELERS 61472881203 1IN 1GVE""LE
TOP
❑ ,J� CITATION# CHARGE OTTOM
LEGALLY YES N`L J
25 s 7 6
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. EE79886
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4499
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'
blue suv rear blue suv
Within the city limits of Renton/King/WA I responded to a 2 car crash near the 1200 block of Hoquiam
Ave NE.
I contacted the driver of unit 2 who said she was just slowing when she was hit from behind by unit 1.
She did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he slid on the wet roads and
contacted the back of unit 2. He did not complain of injury and damages did not require a tow truck.
There was obvious old damage on the front of unit 1. Unit 1 was unable to provide valid proof of
insurance.
I cited unit 1 ref RCW 46.61.145 Following too close 2 car crash and Ref RCW 46.30.020 No valid
proof of insurance via complaint.
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 4/25/20204
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 04:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 5/23/2024 5:56:24 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 2:29 Pry TIME POLICE ARRIVED 2:46 PM
PART I PAGE IT]OF
REPORT NO. EE79886 CASE# ' 24-4499 DATE AND TIME 04/25/24 14:27
OF COLLISION
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