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 i } i PAGE 3 OF 3