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HomeMy WebLinkAbout24-5166 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 SASE 24-5166 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT 8 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 1435 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ S 3RD ST BLOCK e✓ 900 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e S.WILLIAMS ST 2 0 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4253293455 0 11 30 6� LAST NAME ANDERST FIRSTNAME EUGENIE MIDDLE K 1 1 2 31 INITIAL STREET ❑ 232 BURNETT AVE S APT A302 CITY RENTON ST WA ZIP 980572171 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO 8❑ LRIIVER # STATE WA SEX'F MM D Y' 08 - 25 - 1957 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑ 3 10 1❑ PI ATE 14 CKV9565 STATE WA VIN# JHMGK5H58GX002438 11[-j- TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# IR.. ro TRLR. TRLR 7 3 33 12 2 5 VIN#j VIN# :: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE ] $ 34 13 1 2016 HOND FIT HB DAMAGE vesNo ves❑ No REGISTEREDOWNERINFO EUGENIE ANDERST 232 BURNETT AVE S APT A302 RENTON WA 98057 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE U INSURANCE CO SAFECO H2571389(5.25) 4 IN EFFECT &POLICY# 9TOP VEHICL' CHARGE 5 36 LEGALLv YEs❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067413767 16 a LAST NAME VANELSBERG FIRST NAME DEREK MIDDLE I,/ INITIAL 17❑ STREET ❑', 14231 150TH PL SE CITY RENTON ST WA ZIP 980597461 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑ 19[-] DIVER # {NJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑ 21❑ LICENSE BJD5019 TATe WA VIN1i JN16J1CR5HW115856 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2017 MAKE NIS$ MODEL ROUGUE STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO DEREK VANELSBERG 14231150TH PL SE RENTON WA 98059 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU PORGY#ECO STATE FARM 4268135BI247D(8-24) IN VE""LE ❑ ,J� CITATION# CHARGEUQ, LEGALLYYES N`L J25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 C.JACOBS 1953 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. EF03155 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5166 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) GONZALEZ LESLIE G (LAST FIRST, ADDRESS&PHONE# 14231 150TH PL SE RENTON WA 980597461 2067413766 SEXi F MMDDYyry 03 - 27 - 1997 PASSENGER Z WITNESS❑ UNIT# 2 PEA 'I 3 AIRBAG 12 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES USE 1 2 CLASS '1 NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' On 5-14-24 at about 1445 1 arrived in the 900 block of S 3rd Street for a 2 vehicle collision. I contacted both parties who identified themselves via WADL. Driver 2 told me; He was driving eastbound on S 3rd street when unit 1 changed lanes into the side of his vehicle. Driver 1 confirmed the accounts of the collision. No injuries and vehicles were released to the drivers. This collision occurred in the city or Renton, County of King. I declare under penalty of perjury under the laws of Washington state that the foregoing istrue and correct. C. Jacobs I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.JACOBS 05-15-24 07:31 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 8/7/2024 2:13:44 PM BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED! Y:39 Pry] TIME POLICE ARRIVED 2:45 PM PART I PAGE IT]OF 3� REPORT NO. EF03155 CASE# ' 24-5166 DATE AND TIME 05/14/24 14:35 OF COLLISION �li� iPpr a , CD 1 ( rY� (f 4 i } I i =1 t4 PAGE 3 OF 3