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HomeMy WebLinkAbout24-5138 IT ' " . 27POLCERAFFO 1 c 1I1llI 111I II REPORT NO EE83089
COLLISION REP FIT
1591971
CASE 24-5138 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 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#
cowsloN 05 - 1-- 2024 1107 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON DR S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV e EAGLE RIDGE DR S
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2065146661 0 11
30
6� LAST NAME NSEREKO FIRSTNAME COLLINS MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 1300 EAGLE RIDGE DR S APT T11 CITY RENTON ST WA 2jp, 980553423 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 USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 CJK8647 STATE WA VIN# 3KPF24AD7PE649941
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34
13 2 2023 KIA FORTE DAMAGE vE5 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO PHEIBE NABATANZI 1300 EAGLE RIDGE DR S APT TII RENTONWA98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
LEGALE CHARGE to BOTTOM 5 36
LE—Lv res No CITATION# 4A0361497,4A0361497 FAIL YIELD LEFT TURN MOTOR
15❑ STANDING 6
MOTOR PEDAL-: PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:2069399766
16 a
LAST NAME SCHLEGEL FIRST NAME MIRA IN DOLE K
IN MIDDLE
17❑ STREET ❑', 324 WILLIAMS AVE N CITY' RENTON ST WA ZIP 980575613 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs It I NOF YES
t t- l NO❑
19 F] LDI IVEW # STATE WA ]SEX IF M DDY
D.C.B.
03 �_ 10 _ 2004 El 39
WELMET INJURY NATURE OF INJURIES 4O
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CGS1815 TATe WA VIN# KNDJT2A51C7463892
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2012 MAKE KIA MODEL SOUL STYLE VEHICLETOWED TO BLIN TOWEDBv GOV HI �44
24❑ DAMAGE YES NO GENE MEYER YES 11
REGISTERED OWNER INFO MIRA SCHLEGEL 324 WILL..AVE N RENTON WA 98057 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 9TOP 5
VEwCLE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N`L J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE83089
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5138
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 05-14-24 12:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 6/3/2024 11:32:40 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 11:07 AM TIME POLICE ARRIVED 11:08 AM
PART I PAGE IT]OF 4]
REPORT NO. EE83089 CASE# 24-5138 OF COLLISION
05/14/24 11:07
OF CbLLI510N
NARRATIVE
blk sewn/1 It e to sb wht cude/2 nb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Benson Rd S at Eagle Ridge Dr S.
I contacted the driver of unit 2 who told me she was northbound on Benson Rd S when unit 1 made a
left turn in front of her vehicle from Eagle Ridge onto Benson. Unit 2 said there was no space to
avoid unit 1 illegal turn. She did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he was making a left onto Benson
Rd when he collided with unit 2. He told me he did not have insurance for his vehicle. He did not
complain of injury and damages required a tow truck.
I cited unit 1 ref RCW 46.61.185 FTYROW left turn 2 car crash and ref RCW 46.30.020 no valid proof
of 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 5/14/2024
PAGE 3 OF 4
REPORT NO. EE83089 CASE# ' 24-5138 DATE AND TIME 05/14/24 11:07
OF COLLISION
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