No preview available
HomeMy WebLinkAbout24-4537 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-4537 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENC 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 TOTAL#OF OBJECT 1 1 7 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'. 04 - 1-- 2024 1345 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RAINIER AVE S BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e SW GRADYWAY 1 9 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO �/ D:2063718879 1 9 30 6� LAST NAME FLOWERS FIRSTNAME WILLIE MIDDLE B 1 1 2 31 INITIAL STREET ❑1 4518 S THISTLE ST CITY SEATTLE ST WA ZIP, 981184644 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES NO LRIIVER # STATE WA SEX'M I EL MI MIT Y 8❑ ' 12 — 03 — 1951 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 P1 ATNES# C763662 sTAT WA v N# 2FTHF25H6RCA85184 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. RLR 1 7 33 12 3 5 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 7 34 13 2 1994 FORD F250 DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO WILLIE FLOWERS 4518 S THISTLE ST SEATTLE WA 981184644 D:2063718879 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO GEICO 1847-37.73.00 3 4 IN EFFECT &POLICY# 9TOP VE—LE 5 36 LEGALLY Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ 16 a OWNER ❑ YES 1/ NO D:8326890652 LAST NAME KOSHAR FIRST NAME XIAO MIDDLE I D INITIAL 17❑ STREET ❑', 411 BAKER BLVD UNIT 606 CITY' TUKWILA ST WA ZIP 981883095 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES t l NO❑ 19 LICENSE# STATE WA ]SEX IF M.C... 10 _ 14 1962 El 39 WELMET INJURY 7 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 USE CLASS HEAD ACHE 21❑ LICENSE I CBW6104 TATe WA VIN1t JTDKTUD38ED582960 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2014 MAKE TOYT MODEL YARIS STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO GENE MEYER YES NO REGISTERED OWNER INFO XiAO KOSHAR 411 BAKER BLVD UNIT 606 TUKWILA WA981883095 D:8326890652 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU&PORGY#E CO GEIC04369-60-72-56IN 1GQ'E"'LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 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. EE79889 COLLISION REPORT III III III III III 111 1591972 CASE# 24-4537 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 PM 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 04-26-24 02:35 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 5/23/2024 6:07:15 PM BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 1:46 PM TIME POLICE ARRIVED 1:50 PM PART I PAGE IT]OF 4� REPORT NO. EE79889 CASE# 24-4537 OF COLLISION 04/26/24 13:45 OF CbLLI510N NARRATIVE red rear wht truck RTF Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at Rainer Ave S at SW Grady Way. I contacted the driver of unit 2 who was on the phone and was confirming she was going to the hospital. She told me she was merging onto Grady from Rainier Ave S when she was hit by unit 1 from behind. She said she had a head ache. Although damage was minor to unit 2 she had it towed. After Fire checked and released her and left the scene, I requested they come back to the scene with a Tri-Med in tow. She was transported by Tri-Med to VMC-ER for additional checks. While unit 2 was seated in her vehicle she did not appear to have any trouble moving about while seated. She walked around her car to the passenger side and sat down on the stretcher with no apparent mobility issues. I contacted the driver of unit 1 who told me he was just starting to proceed because unit 2 was already going and then she had abruptly stopped. He contacted the back of her car that caused no signs of damage to his truck. He said he just bumped her car. He did not complain of injury. 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 4/26/2024 **** AUTO-POPULATED SECTION **** THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER": Motor Vehicle Unit 1 Action Code: JUST MERGING Motor Vehicle Unit 2 Action Code: MERGE AND STOP **** END OF AUTO-POPULATED SECTION **** PAGE 3 OF 4 REPORT NO. EE79889 CASE# ' 24-4537 DATE AND TIME 04/26/24 13:45 OF COLLISION Y�Ll. l 1 �c x' AN, i ar. F r PAGE 4 OF 4