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HomeMy WebLinkAbout24-8090 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 SAS 24-8090 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AGENCI 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 1 1 8 28 TOTAL#OF OBJECT i TRIBAL UNITS 03 STRUCK' FENCE RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION'. OS — 02 — 2024 1420 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ UNION AVE NE BLOCK NO. e✓ ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e NE 19TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4252693589 0 11 30 6� LAST NAME LINDBECK FIRSTNAME KIMBERLEE MIDDLE W 1 1 2 31 INITIAL STREET ❑ 1822 QUEEN PL NE CITY RENTON ST I WA 2jp, 980563387 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO 8❑ LRIIVERS STATE WA SEX'F MM DAY' 02 1— 14 — 1969 2 32 CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 ATE 14 BJY9991 STATE WA VIN#' 5XXGW4L26GG021977 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FR.. ro TRLR. TRLR 7 3 33 12 3 0 VIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34 13 2 2016 KIA OPTIMA DAMAGE vE5 0NO agW�MEYER vEs❑ No REGISTERED OWNER INFO KIMBERLEE LINDBECK 1822 QUEEN PL NE RENTON WA 980563387 D:4252693589 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 910250329 4 IN EFFECT &POLICY# 9TOP vEHICLE CHARGE 5 36 LECALLv res❑NO❑ CITATION# 4A0652620 FAIL STOP AT STOP 1 o BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL-: PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252269334 16 a LAST NAME JOSS FIRST NAME BETTY-LOU MIDDLE N INITIAL 17❑ STREET ❑', 9805 126TH AVE SE CITY RENTON ST WA ZIP 980562473 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 D IVEW # STATE WA SEX F M .C... 08 _ 16 _ 1938 39 20❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 JJ HELMET INJURY 7 NATURE OF INJURIES ❑ 40 USE CLASS TBD 21❑ LICENSE BPN0497 TATE WA VIN# 4T1BE32K83U175597 ❑ 41 pLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. N#. 43 RLR 'I VEH YEAR 2003 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44 24❑ DAMAGE YES NO GENE MEYER YES NO REGISTERED OWNER INFO BETTY-LOU JOSS 9805126TH AVE SE RENTON WA 980562473 D:4252269334 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU&POLICY#E CO PEMCO CA 02468 18IN 970E 5 'E""LE ❑ Nu,J CITATION# CHARGE LEGAL io BOTTOM LY YES 25 ' e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 M.LEVERTON 2517 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF03720 COLLISION REPORT III III III III III 111 1591972 CASE# 24-8090 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' wht blu fence CC Within the city limits of Renton/King/WA I responded to a 2 vehicle blocking crash at the intersection of Union Ave NE at NE 19th St. I contacted the driver of unit 2 who told me she was northbound on Union Ave NE when unit 1 pulled from NE 19th St and crashed into her. The impact caused her to deflect and continue in a NE direction crashing into a fence to a residential backyard. She was checked by Renton Fire on scene and later transported by Tri-Med to VMC for any additional checks/treatment. He vehicle was impounded for damages. I contacted the driver of unit 1 ID'd by picture WADL. She told me she was crossing Union from 19th eastbound when she contacted unit 2. She told me she didnt see unit 2. She did not complain of injury and damages did require a tow truck. I cited unit 1 Ref RCW 46.61.190 FTYROW-Stop Sign 2 car crash via complaint. 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 8/6/2024 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 08-06-24 03:02 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 8/9/2024 10:52:31 AM BADGE OR ID# Y517 ORI# WA0171300 TIME POLICE DISPATCHED 2:21 Pry TIME POLICE ARRIVED 2:28 Pry PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. EF03720 r` POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-8090 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE u PEDESTRIAN � OWNER � YEs� NO D:2067180128 MIDDLE.. 29 LAST NAME GALLO FIRST NAME GREG INITIAL A STREET 30 NEW AnDRFSP' 1901 VASHON CT NE CITY RENTON ST WA ZIP 98059 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]Na� YEs N L DRIVER'S STATE I SEX M M�DDYBYv 03 - 09 - 1957 LICENSE 7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE GLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIC P FROM TO DAMAGE Y E ES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NEW AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN 39 LICENSE # PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 08-06-24 03:02 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 2517 O#IL WA0171300 JOHNSON 81912024 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EF03720 CASE# ' 24-8090 DATE AND TIME 08/02/24 14:20 OF COLLISION t fiyy - h4#f try, sty �4 t t\ S} 11 t t t , P i h t PAGE 4 OF 4