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HomeMy WebLinkAbout24-7611 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-7611 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 1 TOTAL#OF OBJECT 1 1 7 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
COLLISION' 07 - 19 - 2024 1007 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e AIRPORT WAY
0 3 29
UNIT MOTOOR Z CYDDAL ❑ DYESA✓NOESHOLDMET PHONE 0 3 30
6� LAST NAME WINSTON FIRSTNAME VIVIAN MIDDLE K 1 2 31
INITIAL
STREET ❑ 17901 105TH PL SE APT N310 CITY RENTON ST WA ZIP' 980556433 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 1❑ P1 ATE 14 CMC7059 STATE WA uN# 1C4PJLCB8KD444653
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TREK. YRLR. 5 3 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 3 34
13 2 2019 JEEP CHERO DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO VIVIAN WINSTON 11101105TH PL SEAPTN310 RENTON WA 98055 D:4255241597 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN
16 a PROPERTY DAM THR OLD MET PHONE
UNiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2533320392
LAST NAME KREISSL FIRST NAME CHRISTIAN MIDDLE N
INITIAL
17❑ STREET ❑', 29617 114TH AVE SE CITY AUBURN ST WA ZIP 980922564 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 LICENSE# STATE WA SEX M MMDDW 07 10 _ 1964 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CLS4685 TATE WA vIN# 3WFB7AX9RM032191
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2024 MAKE VOLK MODEL TIGUAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO L RECARO AIRCRAFT SEATING AMER]2275 EAGLE PKWY FORT WORTH TX 76177 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IUQ'E""LE
❑ ,J� CITATION# CHARGELEGALLYYES N`L J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE97379
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7611
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'
slv suv2 blk suv 1 rt vs lane change
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash near the intersection of Rainier
Ave S at Airport Way.
I contacted the driver of unit 1 who told me she had just turned from Rainier onto Airport when unit 2
changed lanes and contacted her vehicle causing some damage on the passenger side. She did not
complain of injury and damages did not require a tow truck.
I contacted the driver of unit 2 who told me he was in the right turn lane of Rainier Ave S and as he
was making his turn onto Airport Way unit 1 crowded his lane with her vehicle contacted her vehicle.
He did not complain of injury and damages did not require a tow truck.
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 7/19/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 07-19-24 10:50 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 7/19/2024 3:37:47 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 10:10 AM TIME POLICE ARRIVED',10:15 AM
PART I PAGE IT]OF
REPORT NO. EE97379 CASE# ' 24-7611 DATE AND TIME 07/19/24 10:07
OF COLLISION
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