HomeMy WebLinkAbout24-7976 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-7976 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 07 - 1-— 2024 1725 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAWER AVE S
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 00 FEET e S B W e S 2ND ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2065103936 0 11
30
6� LAST NAME BOOTS FIRSTNAME LEIF MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 13825 DES MOINES MEMORIAL DR CITY BURIEN ST WA 2jp, 98168 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEXI M MIDI Y' 07 — 31 — 1964 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE C01846D sTArI WAVrN# 1GCEK19T8YE335833
10 F91 PI ATE#
11[—j— TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
rRLR. TRLR 7 5 33
12 3 5 VIN# YIN#
VlN FROM TO
❑ VEH.YEAR 2000 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 CHEV SILVER PK DAMAGE vesNo ves❑ NO
REGISTERED OWNER INFO LEIF BOOTS 13825 DES MOINES MEMORIAL DR BURIEN WA 98168 D:2065103936 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO NONE NONE 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
�LEGALL,v Yes❑NO❑ CITATION#15❑ NNG MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
NIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:2539511776
16 2
LAST NAME KWANGAYA FIRST NAME OMARI MIDDLE K
INITIAL
17 STREET❑ NEW ADDRESS❑' 30826 54TH AVE S CITY AUBURN ST WA ZIP 98001 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 RRS LDI IVE STATE WA SEX M M .O.B. 08 _ 27 1972 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# 41
C65036R TArE WA VIN1 1FTSW31S5XE685751 1
42
22❑ TRAILER 106O95AD STATE WA TRAILER STATE
PLATE# PLATE#
43
23❑ NL 5R8D51028FM036085 NL#
VEH YEAR 1999 MAKE FORD MODEL F250 STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO OMARI KWANGAYA 3082654TH AVE S AUBURNWA98001 D:2539511776 VEHICLE NO.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 02633265-8IN 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE io BOTTOM
LEGALLY YES N`LJ
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEV/N PETERSON 12808 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF02466
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7976
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,FIRS 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'
I was dispatched to a collision on 07/29/24 at 1726 hours at Rainer Ave S and S 2nd St , in city
Renton, King County WA.
Unit 1 C01846D Driver: Leir A. Boots (DOB 07/31/1964)
Unit 2 C65036R Driver: Omari K. Kwangaya (08/27/1972)
Unit 2 stated that he was traveling South on Rainer Ave S in lane 2. Unit 2 stated that Unit 1 was
pulling out the parking lot of Auto Zone when he went into Unit 2's lane and both Units collided. Unit 1
stated he was pulling out of Auto Zone parking lot turning right when he stated Unit 2 was going pretty
fast and hit him.
Both drivers refused medical on scene. Both drives had the same account of what happen.
Upon request Boots was unable to provide proof of insurance and was cited for driving a motor
vehicle without insurance. Boots had a driver's license that was suspended or revoked in the third
degree and was cited for driving a vehicle while his license was suspended.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 07-29-24 08:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 81512024 2:22:08 PM
BADGE OR ID# ! 12808 ORI# WA0171300 TIME POLICE DISPATCHED; 5:26 PM TIME POLICE ARRIVED',5:30 PM
PART I PAGE IT]OF 3�
REPORT NO. EF02466 CASE# ' 24-7976 DATE AND TIME 07/29/24 17:25
OF COLLISION
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