HomeMy WebLinkAbout24-10265 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF22200OLCERA COLLISION REPORT 1591971 CASE# 24-10265 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LdCAI-AGENCY 4150 3 C©DING COUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E IN eDLLIs[oN' 09 - 21 - 2024 12?5 17 =.= S 8 W E OF M 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. e .� 4a NE 4TH ST MILE POST ❑ ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES�.� FEET e S 8 W e UNIONAVENE 0 1 29 MOTOR PEDAL- DAM AG TSHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO 0 8 30 5 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31 INITIAL STREET F� NEW ADDRESS CITY', RENTON ST: ZIP: 2 7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3 INTERLOCKYEs NO INTERLOCKVEs NO YES NO 8❑ LCEENSE# SRVERISTTATE SEX U MMDDYY' —=— 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 HELM USEET 9 CLASSY 0 NATURE OF INJURIES 2 LICENSE, 3 10� PI ATF# STATE V(N TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR TRLR 7 3 33 12 0 Q VIN#'. VIN#: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 9 9 34 13� DAMAGE YES�NO� YES❑ NO REGISTERED OWNER INFO DENZIL TTRACEY 5020 NE 2ND CT.RENTON WA 98059 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 3 4 14❑ LIABILITY INSURANCE❑ NSURANCE CO IN EFFECT &POLICY# 9TOP VEnic'E CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# t a BOTTOM 15❑ STM ING 7 e MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2068356878 16� LAST NAME PURCELL FIRST NAME DAVID MIDDLE I S INITIAL STREET ❑ 37 17 ❑ 1502 S 6TH ST CITY' RENTON ST, WA ZIP 980573952 g NEW ADDRESS 1$❑ CDL IGNITION RE€]UIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCKYEs X YESFINOFYEs NO 19[� DRIVER'S ' STATE WA SEXI M D.O.e. 08 25 1952 � 39 LICENSE# MMDDYY — 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40 USE CLASS HEAD/NECK 21[ LICENSE I PATE# BUC2884 rare WA vIN# 1 GNEVJKW9KJ294811 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2019 MAKE CHEV MODEL TRAVERS STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO REGISTERED OWNER INFO PURCELL PAINTING AND COATINGS 6456 S 144TH ST TUKWILA WA 98168 D:2068356878 VEHICLE NO.2 SHADE IN DAMAGEAREA 2 3 LIABILITY INSURANCE INSURANCE CO SAME. IN EFFECT &POLICY# t STOP LVEHICLE '—LY YES N CL] CITATION# CHARGE to BOTTOM LEGALL 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 M.LEVERTON 2517 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF22200 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10265 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CIASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE unit 1 slv suv female driver WF 30yo-sh dark hair wht/unit 2 lane 2 stopped eb Within the city limits of Renton/King/Wa I responded to Renton City Hall for an ISR-in station report. I contacted the RP who told me was the victim of a hit and run from 09-21-2024 1215 hours at NE 4th St at Union Ave NE. He told me he was stopped eastbound lane 2 NE 4th St when he was hit from behind. He told me his neck/head was sore as a result but felt better within one day. He told me he got out of the car to contact the female driver who was verbally rude to him. He pointed to the close parking lot to pull over and exchange info and the driver of unit 1 left the area without providing the information required by law. Unit 2 described the driver as a white 30-ish year old female with dark hair. This description did not match the RO. The damage to unit 1 based on the picture provided by unit 2 showed the damage was basically unremarkable. Unit 2 did not expect criminal prosecution. 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 10/01/2024 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 10-02-24 07:11 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 101712024 12:34:57 PM BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 11:45 AM TIME POLICE ARRIVED i 11:53 AM PART B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3 REPORT NO. E F22200 CASE# 24-10265 DATE AND TIME 09/21/24 12:15 OF COLLISION tA 5 v, yi# li. r z It s ti� , 2 � 1 � I`t t� } rr �t a 4 � , Y �r�ru}bj y I Y M 1 � t PAGE 3 OF 3