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HomeMy WebLinkAbout24-9022 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-9022 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING'
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 08 - 1-- 2024 1602 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
TALBOT RD S MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV e S PUGET DR
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2063080986 30
6 LAST NAME RAMIREZ DIAZ FIRST NAME ROLANDO MIDDLE N 1 2 31
INITIAL
STREET ❑ 1224 SW 124TH ST APT 102 CITY BURIEN ST WA 2jp, 981462635 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❑ P1 aT�S� C96077N sTATI WAvIN# 1 FTRF12227KD22213
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 5 1 33
12❑ VIN#' VIN#.
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2 2007 FORD F150 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO YIMY TREJO RI.11400 MILITARY RD S APT 4 SEA TTLE WA 98168 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 3 4
14 2 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
VEHCLE CHARGE 10 BOTTOM 36
LEGALLY YES❑NO❑ CITATION# 4A0652627,4A0652627 SPEED TOO FAST FOR CONDITIONS,
15❑ STANDING 7 6
UNIT 0' MOTOR ❑ PEDAL ❑ PEDESTRIAN ❑✓ PROPERTY ❑ DAM THR
VEHICLE CYCLE OWNER YES V NO OLD MET PHONE
16 a
LAST NAME MCKINNEY FIRST NAME MALEAH MIDDLE S
INITIAL
17❑ STREET ❑', 11905 SE 260TH PL CITY KENT ST WA ZIP 98030 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 F] DRIVE # STATE SEX F MmD D.
IF 03 _ 29 _ 2005 39
ON DUTY STATUS 3 AIRBAG RESTR EJECT , HELMET I INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS L ELBOW
❑21❑ LICENSE TATE vIN1 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 0 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES Nu
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
M.LEVERTON 2517 [V7�ENCY
A0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF10937
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9022
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 08-28-24 07:10 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 9/2/2024 12:18:18 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 4:03 pry] TIME POLICE ARRIVED]4:08 pry
PART I PAGE IT]OF 4�
REPORT NO. EF10937 CASE# 24-9022 OF COLLISION
08/27/24 16:02
OF CbLLI510N
NARRATIVE
blu tk In 1 nb yellow ped x walk e 2 w
CC
Within the city limits of Renton/King/WA I responded to a blocking car v ped at the intersection of
Talbot Rd S at S Puget Dr.
The Ped was seated on the traffic island and being tended to by Renton Fire when I arrived. Fire
provided me with her name and dob. I clarified with her the information was correct. Her priciple
complaint for injury was elbow, shoulder and hip. She did not provide very many details in reference
to the incident. The only information 1 was able to get is she was attempting to cross from the east to
the west from the south side of the intersection when she was struck from unit one and pushed into
the intersection about 10-15 feet. She was later transported to VMC -ED by Tri_med for further
checks.
Officer Catalan interviewed the driver of unit 1 in Spansih. He told me that unit 1 was headed
northbound in lane 1 and was trying to make the yellow light when he contacted the ped. The driver
also said his light was green and was pointing to a location a ways back. Unit 1 tried to explain how
far back he was when he started to brake. His story did not seem to make much sense since his
approximate braking location versus the lights changing from green to yellow would have given even
an poor skilled driver plenty of time to stop. Unit 1 was operating a company and was unable to
provide valid proof of insurance for his truck.
I cited unit 1 via complaint ref RCW 46.61.400.1 Speeds too fast for conditions pedestrian collision
and RCW 46.30.020 No valip proof of insurance.
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 8/28/2024
PAGE 3 OF 4
REPORT NO.! EF10937 CASE# ' 24-9022 DATE AND TIME 08/27/24 16:02
OF COLLISION
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PAGE 4 OF 4