HomeMy WebLinkAbout24-7933 IT �iNII I IIII �� I I III I I IIII IIIII I 27c REPORT NO.STATE OF
COLLISION REPORT 1591971
CASE# 24-7933 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ VEHICLE ❑ LOCAL AGENCY 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TRIBAL TOTAL 1
UNITS#OF 02 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
coLLISION' 07 - 28 - 2024 1638 17 =.= S 8 W e IN OF e 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
S 2ND ST MILE POST
❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �. FEET e S 8 W e LAKE AEV S
2 0 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
VEHICLE ❑ CYCLE' ❑ YES ✓NO O 1 30
UNIT 01
5❑ LAST NAME EASTMAN FIRST NAME MARGARET MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 13842 SE 241ST ST CITY KENT ST WA ZIP 98042 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 3
INTERLOCKYEs NO✓ INTERLOCKYES NO✓ YES D NO'✓
8❑ DRIVECEN STATE WA SEX F MMDCSYY' 08 - 21 - 1981 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 1 INJURY
CLASS 1 NAruRE of INJURES 2
LICENSE, CLY3502 STATE WA VIN# JTMBK33V185068575 3
10[9� PI ATF#
11[-j— TRAILER STATE TRAILER ,STATE ROM TO
11 0 0 PLATE# PLATE#
TRLR rRLR, 3 7 33
12 0 Q VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 1 2008 TOYT RAV4 UT DAMAGE YES DNO ✓ YES❑ NO✓ 3 34
REGISTERED OWNER INFO TODDJOHNSON 16642158TH PL SE RENTON WA 98053 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 ✓ PROGRESSIVE 917132035
IN EFFECT &POLICY# 4TOP ❑
VEHICLE CHARGE 5 36
Lemur YES❑NO❑ CITATION# 7 o BOTTOM
15❑ sTnNowc 7 e
UNIT OZ MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE. OWNER YES✓ NO
16�
LAST NAME BLACKBURN FIRST NAME JOANN MIDDLE I B
INITIAL
STREET ❑
17 ❑ 135 HIGHWA
NEW ADORE Y 20 E CITY COLVILLE ST, WA ZIP 99114 4 37
SS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. 38
INTERLOCKYEs ND✓ jNTERLOCK YES No,/ yEs NO I✓
19 LICENSE#DRIVER'S STATE WA SEX U MD D2-D.0.B. 04 12 - 1958 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 SE CLAY 1 NATURE OF INJURIES 40
SS
21 LICENSE CDL9023 rare WA vIN# 1 HGEM21513LO45324 41
22❑ [TILER TAILER
PLATE# STATE PRATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2003 MAKE HOND MODEL CIVIC STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 4701059E2647B
IN EFFECT &POLICY# 9TOP
veHiaE
A r CITATION 11
CHARGEYES❑ NLJ tO BOTTOM
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
E.EDMUNDS 12576 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO.
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7933
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET N NATURE OF INJURIES
El POS. USE CLASS LASS
'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
Unit#1 was travelling westbound on S 2nd St in lane 2 (counting north from the southern curb). Unit
#2 was traveling the same direction in lane #1. The driver of Unit#1 attempted to merge from lane 2
into lane 1, not seeing Unit#2 approaching. Unit#1 struck Unit #2 as it merged into lane 1, which was
already occupied by Unit#2. An improper merge by unit#1 appeared to be the proximate cause of
the collision.
Both driver's provided a valid driver's license, registration certificate, and current proof of insurance.
Firefighters responded to the scene for evaluation. No immediate medical teratment or transport was
necessary. Both vehicles were visibly damaged, but drivable. I provided an exchange of information
to both parties.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by E. Edmunds/#12576 at 1715 hours on 07/29/2024, in the City of Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.EDMUNDS 07-28-24 05:22 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
8/5/2024 2:22:20 PM
P.SUMMERS 8887
BADGE OR ID# 12576 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 4:38 PM TIME POLICE ARRIVED 4:38 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. CASE# 24-7933 DATE AND TIME 07/28/24 16:38
OF COLLISION
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