HomeMy WebLinkAbout24-6151 STATE OF I� I �I) ,1�1ll�111(III IN�I I) SUPPLEMENTALREPORT NO. EE86207 1 0 27
COLLISION REP FIT 1591971
SASE# 24-6151 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ STOLE F ❑ LOCAL AGENCY 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK'
RESERVATION
z
3 DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E CITY# ❑
cowsloN 06 - 11 - 2024 1304 17 ❑.= S IN 1070 3
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LK WA BL N BLOCK NO.
1❑ e✓ ❑
MILEPOST
4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV a SB 1-405
0 4 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE 0 11
30
6� LAST NAME SABURI FIRSTNAME KEON MIDDLE Y 1 1 2 31
INITIAL
STREET ❑ 7420 117TH PL SE CITY NEWCASTLE ST WA ZIP 980561758 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ pl ATFBit AMG1011 sTAr� WA VrN# JTEBU46F9DK169350
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FRom ro
TRLR. TRLR. 3 5 33
12 2 5 VIN#' VIN#'
FROM TO
VEH.YEARN MAKE TOYT MODEL FJ STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 2 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO EUGENE SABURI 7420111TH PL SE NEWCASTLE WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VErIICLE CHARGE 5 36
LE-ALLv YES No CITATION# 4A0361522 FAIL YIELD LEFT TURN MOTOR o eorrom
15❑ NDING 8 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
VEHICLE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑
16 a CYCLE OWNER YES 1/ NO
LAST NAME LAM FIRST NAME HOU MIDDLE W
INITIAL
17❑ STREET ❑', 1020 108TH AVE NE APT 1604 CITY BELLEVUE ST WA ZIP 980048677 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK vEs It I NOF YES
t t- l NO❑
19[—] DRIVER'S STATE WA SEX M D.O.B. 07 12 _ 1993 0 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS HAND
21❑ LICENSE I BPX6560 TArE WA vIN# 5YJXCBE4XKF185305
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
%
RLR
'I
VEH YEAR 2019 MAKE TESL MODEL MODEL X STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO BYLINGTON AND ENTERTAINMENT LL 14150 NE 20TH ST STE FI-186 BELLEVUE WA 98007 D:4259225116 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE E
BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE86207
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6151
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'
sil left turn blk tesla eb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at Lk Wa BI N just
under 1-405.
1 contacted the driver of unit 2 who told me he was west on Lk Wa BI N when unit 1 turned left directly
across his path making contact with his vehicle. He complained of a hand injury. He was checked
and released on scene by Renton Fire. His vehicle required a tow truck for damages.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he was west bound and attempting
to make a left turn onto south 1-405 when he contacted unit 2. He did not complain of injury and
damages did not require a tow truck.
I cited unit 1 ref RCW 46.61.185 FTYROW-Left Turn 2 car crash 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 6/11/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 07-19-24 06:33 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 6/13/2024 7:05:48 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 4:04 Pry TIME POLICE ARRIVED f 1:15 PM
PART I PAGE IT]OF
REPORT NO. EE86207 CASE# ' 24-6151 DATE AND TIME 06/11/24 13:04
OF COLLISION
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