HomeMy WebLinkAbout24-5906 OLICETRAFFIC II I III I III I I III I I IIII III III REPORT NO. EE85815 0 5 27
j COLLISION REPORT 1591971
CASE# 24-5906 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOL`CO AGENCY. 4100 3
COUNTY RD INVOLVED CODING
2❑ TOTAL 1
PRIVATE WAY
TRIBAL UNITS#OF 03 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 06 - 04 - 2024 0812 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
N 3RD ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 FEET e S 8 W e BURNETTAVEN
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO O 1 30
6 LAST NAME DAVEY FIRST NAME PHYLLIS MIDDLE L 1 2 31
INITIAL
STREET ❑ 527 WILLIAMS AVE N APT 101 CITY RENTON ST WA ZIP 980575450 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERLOCKYEs NO YES D NO
8 DRIVER'CENS # STATE WA SEX F MMOCSYY' 08 - 19 - 1940 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE'ti� ACG5338 STATE WA VN# 1G4HP52KO34116298 3
11[-j— TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR TRLR 5 1 33
12 3 0 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v 7 3 GOVT VEHICLE 34
13 2 2003 BUIC LES4D DAMAGE YES ONO �MEYER YEs❑ No
REGISTERED OWNER INFO PHYLLIS DAVEY 527 WILLIAMS AVE N APT 101 RENTON WA 980575450 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE NSURANCE CO FARMERS 1689296830 14 3 4
IN EFFECT &POLICY# 4TOP ❑_
sVEHICLE
rgNOLNG ❑ CITATION# 4A0361512 CHARGE FAIL STOP AT STOP o ooTro6 36
ves NO
15
UNIT OZ MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE. nWNFR YES NO
16�
LAST NAME ZARATE PEREZ FIRST NAME AUDENCIO MIDDLE I N
INITIAL
STREET ❑ 37
17 '❑ 6415 BEACON AVE S CITY SEATTLE ST, WA ZIP 981083616
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES No INTERLOCKYEs No YEs No
19[ DRIVER'S STATE WA SEX M I D.O.B. 02 12 1979 ❑ 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG'2 RESTR 4 EJECT 1 HELMET INJURY' 7 NATURE OF INJURIES ❑ 40
USE CLASS CHEST
21 ILICENSEPLATE# AWW1083 rare WA vIN# WMEEJ3BA2FK800355 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2015 MAKE SMRT MODEL FQRTyI/Q STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE vEs�/ No GENE MEYER ves No�/
REGISTERED OWNER INFO BRET GRAY 6415 BEACONAVE S SEATTLE WA 98108 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO ST FARM 401 0050 B25 47B
IN EFFECT &POLICY# 4TOP
LEE— ❑ ,.I—I CITATION# CHARGE t08OTTOM
VEHICLE YES N`.LJ
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EE85815
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5906
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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 06-04-24 10:02 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
6/12/2024 7:26:08 AM
C.JACOBS 1953
BADGE OR ID# 2517 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 9:13 AM TIME POLICE ARRIVED 9:16 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 57
REPORT No.` EE85815 CASE# 24-5906 O COLLI COLLISION TIME
OF 06/04/24 09:12
COLLI
NARRATIVE
1/wht sedan nb burnett 2/wht mini lane 2 eb blue trk park
CC
Within the city limits of Renton/King/WA I responded to a 3 car blocking crash at the intersection of N
3rd St at Burnett Ave N.
I contacted the driver of unit 2 who told me he was eastbound on N 3rd St when unit 1 pulled across
his lane and crashed into him. He complained of chest paint. He was treated and released onscene
by Renton Fire. His vehicle was impounded for damages.
I contacted the RO of unit 3. His vehicle was lawfully parked and unoccupied. As a result of unit 1's
crash with unit 2, unit 1 vehicle continued across the intersection after impact with unit 2 and crashed
into parked unit 3. The damages appeared to be greater than 1000$.
1 contacted the driver of unit 1 ID'd by her picture WADL. She told me the crash was on her as she
told me she did not look left before crossing the intersection from the south side of Burnett Ave N.
She did not complain of injury and damages required a tow truck.
I cited unit 1 Ref RCW 46.61.190.2 FTYROW to vehicle before proceeding from stop sign 3 car 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 6/4/2024
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EE85815
POLICE TRAFFIC
1 1 8 27
µ ^'� COLLISION REPORT CASE#+ 24-5906
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT IGG# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 ❑ NAME # PLACARD
GWVR NO NUMBER
SOURCE AXLES + NAME IF
4a ❑ ADDITIONAL UNITS
,µ MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
UNIT ' 3 PEDESTRIAN �', YES NO
5 VEHICLE CYCLE OWNER
1 4 29
LAST NAME UNKNOWN FIRST NAME MIDDLE'.
INITIAL
STREET 30
NEW ADDRE`A. : CITY SEATTLE ST ZIP
6 ❑ CDL PRESENT MEDICALTANSPORTED 1 31
IGNITION REQUIREb
INTERLOCK YES NO IGNiTiON NTERLOCK YEs NO YEs NO[
G
DRIVER'S STATE SEX U MD.0 8 Y -[-�-
LICENSE;
7
ON DUTY STATUS: AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES
USE CLASS
LICENSE C15330T rar WA VIN# 1N6AAOEC5FN506257
PLATE#
9 TRAILER TRAILER 2
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.# VIN.#.
110 0VEH.YEAR2015 MAKE NISS MODEL TITAN I STYLE VEHICLE TOWE ET ABLIN TOWED BY GOVT VFHICIF FROM TO
DAMAGE YES NO ✓ YES NO
FRANCISCO SANDOVAL 307 BURNETT AVE N RENTON WA 98057 m 33
REGISTERED OWNER INFO. SHADE IN DAMAGED AREA
12
LIABILITY INSURANCE❑ INSURANCE CO FROM TO
TO R
IN EFFECT &POLICY# i "__`___.5 m 34
13 vewc�e YES NO CITATION# CHARGE
D rsorTOM
ecauv
s-rnNoiNc 3 7 G
MOTOR PEDAL_ ' 1:1PROPERTY DAMAGE THRESHOLD MET PHONE 1:1
35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
15 LAST NAME FIRST NAME : INITIAL
❑ 36
16 ❑ STREET CITY ST ZIP
NEW ADDRESS
GDL IGNITION REDID IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YE5 NO INTERLOCK YES No YES NO
17 5 37
LLIICENSE#RIVERS STATE SEX MDowY
18 ❑
HELMET INJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ ❑ 39
LICENSE TAT viN
PLATE# I
#
20 ❑ TRAILER TRAILER ❑ 40
PLATE#. STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# VIN#+.
42
22 VER YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT I &POLICY# tK-99
5 44
vewc�e ❑ ❑ CITATION# CHARGE 24 IEG_ VES NOSTIWDING3 3 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 06-04-24 10:02 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 BADGE OR ID# 2517 O#RI WA0171300 APJACOBS 6111E2/2024
PAGE�OF
3000-345-013(R 11l18)
REPORT NO. EE85815 CASE# 24-5906 DATE AND TIME i 06/04/24 09:12
OF COLLISION
�t
.x¢
s�.
PAGE 5 OF 5
