HomeMy WebLinkAbout25-318 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF58438 170
27
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE zs-318 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 01 - 10 - 2025 0952 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SW 43RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e OAKESDALE AVE SW
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2536538426 0 11
30
6� LAST NAME LI FIRSTNAME SUE MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 23226 61ST PL S CITY KENT ST WA ZIP 980326490 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO I INTERLOCK YES NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
LICENSE CJM4987 sTArI WAurN#' WBXHT3C38J5F89987
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2018 MAKE BMW MODEL X1 STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO SUE LI 1322661ST PL S KENT WA 980326490 D:2536538426 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PEMCO TBA 3 4
IN EFFECT &POLICY# 9TOP
VE"C CHARGE 1 5 36
E.ALLv YES No CITATION# 5A0151250 IMPROPER LANE USAGE o eorrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES V NO D:3602655983
16 a
LAST NAME KNOWLES FIRST NAME G MIDDLE I S
INITIAL
17❑ STREET ❑', 1226 S 35TH ST CITY' RENTON ST WA ZIP 980555790 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 DRIVER'S STATE WA SEX M D.C.B. 07 22 _ 1957 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CNK6357 TAre WA vIN# KM8JECD13RU242387
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2024 MAKE HyUN MODEL TUCSON STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO G KNOWLES 1226 S35THST RENTON WA 980555790 D:3602655983 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ST FARM 568 1237-DO1-47AIN 1ULlliKOTlTlfll;0-
(PRINT)'E""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25 OFFICER'S NAME 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. EF58438
COLLISION REPORT III III III III III 111
1591972 CASE# 25-318
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 01-10-25 02:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 112212025 11:06:51 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 9:56 AM TIME POLICE ARRIVED',9:58 AM
PART I PAGE IT]OF 4�
REPORT NO. EF58438 CASE# 25-318 OF COLLISION
01/10/25 09:52
OF CbLLI510N
NARRATIVE
slv/1 lane 2 blk/1 lane 1 to lane 2
CC
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash near the intersection of
SW 43rd St at Oakesdale Ave SW.
I contacted the driver of unit 2 who told me he was in lane 2 and that unit 1 had made a lane change
from lane 1 into lane 2 into the side of his car. He did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 1 ID'd by her picture WADL. She told me she was making a lane change
and did not see unit 2 until she made contact with his vehicle. She did not complain of injury and
damages did not require a tow truck.
Contact was front fender to front fender.
I cited unit 1 ref RCW 46.61.140 Improper lane use 2 car non injury crash 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 1/10/2025
PAGE 3 OF 4
REPORT NO. EF58438 CASE# ' 25-318 DATE AND TIME 01/10/25 09:52
OF COLLISION
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