HomeMy WebLinkAbout24-6443 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-6443 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 CITY# ❑
COLLISION'. O6 - 19 - 2024 1116 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BL N BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 5001. 00 FEET MILES e S B W e N 3RD ST
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:5099364059 0 11
30
6� LAST NAME GRIEPP FIRSTNAME FREEDOM MIDDLE G 1 1 2 31
INITIAL
STREET El 205 SILVER LN SE UNIT 1 CITY ORTING ST I WA 2jp, 983608015 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
LRIIVER # STATE WA SEX'M MI MIT Y
8❑ ' 04 — 11 — 1978 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS
ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ PI ATFBit 007513A24 sTAr� IL VIN#' 7FCTGAAA7PN025491
[-- TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM ro
rRLR. TRLR. 1 5 33
12 3 0 VIN If VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2023 UNKN DUNE DAMAGE YES NO YEs❑ NO✓
REGISTERED OWNER INFO FREEDOM GRIEPP 205 SILVER LN SE UNIT 1 ORTING WA 983608015 D:5099364059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO LIB MUT AOS26173934640 3 4
IN EFFECT &POLICY# 9TOP
LEIA LE CHARGE 5 36
LEH'C YES❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLDMET PHONE
�Ul
NIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:9373677710
16 a
LAST NAME JUMPER FIRST NAME TIMOTHY MIDDLE I J
INITIAL
17❑ STREET ❑', 2605 14OTH ST SW CITY' LYNNWOOD ST WA ZIP 980871218 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER #
INJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BXV6201 TAre WA VIN# 1GIZD5ST1KF140132
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE CHEV MODEL MALIBU STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES,� YES NO NO GENE MEYER
REGISTERED OWNER INFO TIMOTHY JUMPER 2605140TH ST SW LYNNWOOD WA 980871218 D:9373677710 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STFARM4611413 E1847IN 1UQI
VE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
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. EE89715
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6443
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'
LANE 2 INTO UNIT 2/SIV SEDAN INTO LANE 3 INTO LANE 4
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the 200 block of
Sunset Blvd N.
I contacted the driver of unit 2 who told me he was south bound in lane 3 Sunset Blvd N when unit 1
changed lanes into the side of him pushing him into lane 4. The damaged flattened his front
passenger tire and caused the engine to not restart. He did not complain of injury and damages
required a tow truck.
I contacted the driver of unit 1 who told me he was "getting pressure" from traffic and made a quick
lane change, not seeing unit 2. He hit unit 2 forcing him into another lane. Damage to his vehicle
was minor and 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 6/20/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 06-20-24 07:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 6/24/2024 12:28:54 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 11:17 AM TIME POLICE ARRIVED',11:19 AM
PART I PAGE IT]OF 3�
REPORT NO. EE89715 CASE# ' 24-6443 DATE AND TIME 06/19/24 11:16
OF COLLISION
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