HomeMy WebLinkAbout24-12262 IT �i " II IIIII III IIIII II IIII IIIII I . T 27c REPORT NO EF44143OLCERA COLLISION REPORT 1591971 CASE# 24-12262 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ VEHICLE ❑ LOCALANG 3 HIT&RUN C©DIN6 COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E IN eoLLls[oN' 11 - 26 - 2024 1715 17 �.[� S 8 W e OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLOCK NO. HARD/E AVE SW 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 2001.1 00 FEET e✓ S 8 W e RAINIER AVE S 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2064570934 0 1 30 5❑ LAST NAME MOULTRIE FIRST NAME KEPLEN MIDDLE M 1 2 31 INITIAL STREET ❑ 9400 RAINIER AVE S APT 444 CITY; SEATTLE ST WA ZIP; 98118 2 NEW ADDRESS 7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES NL %/ INTERLOCKYEs NO�/ YES F ND,/ 8❑ DCIENSE# STATE WA SEXI M MMDDYY' 05 - 12 - 2005 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASSY 1 [NATURE of INJURES 2 102] LI ENSE', BXU2167 STATE WA V(N#; 1N4AL11D06N445665 3 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# ROM To TRLR zRLR 1 1 5 33 12 Q 0 VIN#' VIN# FROM TO VEH.YEAR 2006 MAKE NISS MODEL ALTIMA STYLE SD VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 1 $ 34 13� DAMAGE YES II_II NO YESII_I) NO REGISTERED OWNER INFO FRANK USMIAL 4.3 SFONTANELLEST SEATTLE WA 98118 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ NSURANCE CO NONE IN EFFECT &POLICY#VEn" CHARGE 36 Lec Ly YES❑NO❑ CITATION# <14, 15 STANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES NO �/ D:2064063264 16� LAST NAME BECKMAN FIRST NAME MATTHEW MIDDLE ,/ INITIAL STREET ❑ 17 ❑ 22520 SE 456TH WAY CITY ENUMCLAW ST, WA ZIP 98022 4 37 NEW ADORE SS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYEs NO INTERLOCK YES R NO YES NO 19 DRIVER'S STATE WA SEX M D.o.a. 06 12 1989 39 LICENSE# MMDDYYJ I - 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40 21 LICENSLATE E D38943A TATe WA VIN# 1GB3GRCGXK1158188 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2019 MAKE CHEV MODEL EXPRESS STYLE Yy VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO NO REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2 SHADE IN DAMAGAREA 2 3 LIABILITY INSURANCE INSURANCECO AMGUARD INSURANCE COMPANY BEAU456191 IN EFFECT &POLICY# t STOP V—L ❑ ,J—I CITATION# CHARGE to BOTTOM LEGn��Y YES N`,LI 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 E.EDMUNDS 12576 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF44143 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12262 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE Unit 2 was traveling southbound on Hardie Ave SW between SW 7th ST and Rainier AVE S. Unit 1 was traveling directly behind Unit 2. Unit 2 stopped for traffic and Unit 1 was following to closely for Driver#1 to react and safely stop his vehicle before colliding. Driver#2 (Matthew Jeffrey Beckman 06/12/1989) provided a WA driver's license, registration certificate and proof of insurance. Driver#1 (Kei'Len Matthew Eric Moultrie 5/12/2005) was unable to provide any documentation and gave his full name with date of birth. An NCIC/WACIC check was conducted which returned Driver#2 clear and Driver#1 DWLS 3rd. Driver#1 was cited for DWLS 3rd, operating a motor vehicle without insurance, vehicle registration expired by more than two months, and his vehicle was impounded. I provided both drivers with an exchange of information. Driver#1 was also given an impound form, notice of infraction and criminal traffic citation. Both parties left the scene without incident. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by E. Edmunds/#12576 at 2054 hours on 11/26/2024, in the City of Renton, WA. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. E.EDMUNDS 11-26-24 10:01 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY E J.TRADER 4553 DAT 1211012024 12:04:06 AM BADGE OR ID# 12576 ORI# WA0171300 TIME POLICE DISPATCHED 5:15 PM TIME POLICE ARRIVED i 5:15 PM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. E F44143 CASE# 24-12262 DATE AND TIME 11/26/24 17:15 OF COLLISION fi4 Y E � art xu t. v, 1 1 } Y Y fi � Sn t 44 k x ! 2 1 i \y. 1 v 4�re �`. h j PAGE 3 OF 3