HomeMy WebLinkAbout24-8131 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-8131 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 08 - 1-— 2024 1632 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
e✓ --- ----�
S 2ND ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ 300 00 FEET MILES e S ❑ W e LAKEAVES
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4059214862 2 01
30
6� LAST NAME PRICE FIRSTNAME STEPHANIE MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 112 WELLS AVE S,#112A CITY RENTON ST WA ZIP' 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
,OF
Pi ATNES# BZV0361 sTAr WAv N# 3N1CN7AP5Kl877322
IT STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 3 ] 34
13 2014 FORD ESCAPE UT DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO STEPHANIE PRICE 112WELLS AVE S,#112A RENTON WA 98057 D:4059214862 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE U INSURANCE CO GEICO 4631749357 4
IN EFFECT &POLICY# 9TOP
36
VE—LE CHARGE 5❑NO❑ CITATION# 1 o BOTTOM
15❑ LEGALLv STANDING YES 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:8019219665
LAST NAME MARRIOTT FIRST NAME MARCHALL MIDDLE p
INITIAL
17 STREET I❑ 5❑' 14909 175TH AVE SE CITY RENTON ST WA ZIP 98059 4❑ 37
NEW ADORE5
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19[—] LDI IVER # STATE WA SEX M M .C... 04 01 1984 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# A7422231 TArE WA VIN# 5YJ3E1EBOLF649494 1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2020 MAKE TESL MODEL MODELS STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV YES NO HI �44
24 DAMAGE YES NO GENE MEYERS
REGISTERED OWNER INFO MARCHALLMARRIOTT 14909175TH AVE SE RENTON WA 98059 D:8019219665 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSURANCE
#E CO GEICO 6086459432IN 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N J 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# FENCY
26
KEV/N PETERSON 12808 A0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF02471
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8131
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'
I was dispatched to a collision on 08/3/24 at 1632 hours S 2nd St and Lake Ave S , in city Renton,
King County WA.
Unit 1 A7422231 Driver: Marshall P. Marriott (DOB 04/01/1984)
Unit 2 BZV0361 Owner: Stephanie M. Price (12/31/1984)
Unit 2 was driving West on S 2nd St in lane two and as she was approaching Safeway parking lot
Unit 1 hit her in the front passenger side. Disabling her vehicle. Unit 1 was driving down West on S
2nd St in lane three when it saw a bus and tried to change lanes not seeing that lane two had Unit 2
in it and crashed into Unit 1.
Both drivers denied medical attention on scene and reported no injuries.
I gave information exchange to both drivers. Both vehicles were towed off scene.
Both drivers had the same recall of what happen.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 08-04-24 02:21 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 81512024 2:21:52 PM
BADGE OR ID# ! 1Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 4:34 PM TIME POLICE ARRIVED 4:38 PM
PART I PAGE IT]OF 3�
REPORT NO. EF02471 CASE# ' 24-8131 DATE AND TIME 08/03/24 16:32
OF COLLISION
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