HomeMy WebLinkAbout24-12091 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c COLLISION REP FIT 1591971 CASE 24-12091 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING' COUNTY RD PRIVATE WAY INVOLVED 2❑ TOTAL#OF OBJECT 1 1 7 28 TRIBAL UNITS 02 RESERVATION STRUCK z 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# CowsloN 11 - 1-- 2024 0618 17 ❑.= S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ LOGANE AVE N BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e N 4TH ST 0 4 29 MOTOR PEDAL- DAMASHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El �/GE THRENo D:4255241479 0 1 30 6 LAST NAME HAILU FIRSTNAME AYINE MIDDLE A 1 1 2 31 INITIAL STREET ❑ 3131NDEX AVE SE CITY RENTON ST WA 2jp, 980564022 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE WA SEX'M MID D-O B 11 - 23 - 1963 1 2 32 9❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10[1P1 ATE 14 ACP7113 STATE WA u N# JTDBE32K240259640 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM ro TRLR. TRLR. 3 5 33 12 3 0 VIN#' VIN# :: FROM TO ❑ VEH.YEAR MAKE MODEL STYLE IVEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34 13 1 2004 TOYT CAM4D DAMAGE YES NO YES[:] NO✓ REGISTERED OWNER INFO AYINEHAILU3131NDEXAVESE RENTON WA 980564022 D:4255241479 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 rI LIABILIT INSURANCE INSURANCE CO BRISTOL WEST G01 4228391 00 3 IN EFFECT &POLICY# 9TOP vewcLe CHARGE 1 5 36 LECALLv YES❑NO❑ CITATION# 10 BOTTOM 15❑ NDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2067193214 16 a LAST NAME BURRELL FIRST NAME TIMOTHY MIDDLE I L INITIAL 17❑ STREET ❑', 26424 189TH AVE SE CITY COVINGTON ST WA ZIP 980428433 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 LDI IVEW # STATE WA SEX M M D.O.B. 11 01 1956 0 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE AYB0035 TATE WA VIN# JHMCG5659XCO26371 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 1999 MAKE HOND MODEL ACD4D STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO TIMOTHY BURRELL 26424189TH AVE SE COVINGTON WA 980428433 D:2067193214 VEHICLE NO.2 SHADE,IN DAMAGED AREA 4� 3 4 LIABILITY INSURANCE INSU&PORGY#E CO USAA 02040 84 36R 7101 2IN 1U 9TOP 5 VE""LE ❑ ,J� CITATION# CHARGE oBOTTOM 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. EF39415 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12091 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (/AST 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. M.LEVERTON 11-22-24 07:26 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1112512024 12:09:57 PM BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 6:18 AM TIME POLICE ARRIVED 6:23 AM PART B PAGE IT]OF 4� REPORT NO. EF39415 CASE# 24-12091 F LNa O 11/22/24 06:18 F coy�isI©�ON u NARRATIVE blk sedan/2 lane 2 lights out blk sedan/1 left turn lights out RTF Within the city limits of Renton/King/WA I responded to a 2 vehicle blocking crash at the intersection of Logan Ave N and N 4th. When I arrived I located one car blocking southbound Logan in lane 1 just south of the intersection and another on the sidewalk. I contacted the driver of unit 1 who told me he stopped westbound on N 4th St at the intersection. The power was out and the traffic lights were off. (ref RCW 46.61.183) He told me he was making a left turn when he was hit by unit 2. He did not complain of injury and damages did not require a tow truck. I contacted the driver of unit 2 who told me he was in lane 2 and had stopped at the intersection southbound on Logan Ave N. He told me he proceeded forward when unit 1 was now occupying his lane. He told me he swerved but made contact with unit 1. He also contacted his front right wheel on the curb. He did not complain of injury and damages did not require a tow truck. There was no debris in the roadway or any witnesses to corroborate or provide additional information ref this crash. 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 11/22/2024 PAGE 3 OF 4 REPORT NO. EF39415 CASE# 24-12091 DATE AND TIME 11/22/2406:18 OF COLLISION p� I' 7 ti3,y 1 b�k" f t� i4 7n L1 .rs t h �3 4a 5 1 i 5 ' j PAGE 4 OF 4