HomeMy WebLinkAbout23-12260 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12260 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
cowsloN 10 - 1-- 2023 0816 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SE 184TH LN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2533980378 0 7 30
6� LAST NAME JOB FIRSTNAME JESSICA MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 325 RIDGEVIEW DR APT F122 CITY KENT ST I WA 2jp, 980324324 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
8❑ DRIVERS
E# STATE WA SEX'F MM DAY' 01 1- 12 - 1984 2 32
LICEN —, [NATURE OF INJU
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 . EJECT 1 H U EET CLASS 7 I HEAD KNEES RIES z❑
3
LICENE CHR8829 sTArI WAurN# 1HGCD5662TA001242
10 F91 PI ATE#
11[—� TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM ro
PLA YRLR. 5 1 33
12 0 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE J 9 34
13 1996 HOND ACCOR DAMAGE YES NO �MEYER YES❑ No✓
REGISTERED OWNER INFO JESSICA JOB 325 RIDGEVIEW DR APT F122 KENT WA 980324324 D:2533980378 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP
VE— CHARGE to BOTTOM 5 36
LEGALLY YES NO CITATION# 3A0681712,3A0681712 FOLLOW VEHICLE TOO CLOSELY,OP
15❑ STANDING 6
MOTOR PEDAL-:. : PROPERTY DAM THR OLD MET PHONE
UNIT U2 ❑✓ ❑ PEDESTRIAN ❑ ❑ PHONE
2065789934
VEHICLE CYCLE OWNER YES NO
16 a
LAST NAME NGIGE FIRST NAME NATHAN MIDDLE G
INITIAL
17❑ STREET ❑', 32710 4OTH AVE SW CITY FEDERAL WAY ST WA ZIP 980232660 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 .C... 07 15 _ 1993 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BNP7147 TAre WA VIN# 3FA6POLU1JR205404
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE FORD MODEL FUSION STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NATHAN NGIGE 3271040TH AVE SW FEDERAL WAY WA 980232660 D:2065789934 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#ECO ALLSTATE 817 279 418IN 1 9TOP
VE""LE CITATION# CHARGE
LEGAL
25 i o BOTTOM
LY YES Nu
❑ s
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. EE15352
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12260
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.
M.LEVERTON 10-26-23 08:55 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 111112023 2:19:17 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 8:97 AM TIME POLICE ARRIVED',8:22 AM
PART I PAGE IT]OF 4�
REPORT NO. EE15352 CASE# 23-12260 OF COLLISION
10/26/23 08:16
OF CbLLI510N
NARRATIVE
blk sedan/2 stopped trfc lane 2 green sedan/1 ftc rear end
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
108th Ave Se at SE 184th Ln.
I contacted the driver of unit 2 who told me he was stopped for traffic northbound lane 2 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 ID'd by her matching picture WADL. She told me she was following too
closely and was unable to stop for unit 2 when he stopped for traffic and rear-ended him. She was
checked and released onscene by Renton Fire. Damages did require a tow truck. Unit 1 told me she
did not have valid proof of insurance.
I cited unit 1 ref RCW 46.61.145 Following too close two car crash and ref RCW 46.30.020 No
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 10/26/2023
PAGE 3 OF 4
REPORT NO.! EE15352 CASE# 23-12260 DATE AND TIME 10/26/23 08:16
OF COLLISION
NTS
i
PAGE 4 OF 4
