HomeMy WebLinkAbout24-8802 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STIR FIRE CASE
EET ❑
24-sso2 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
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#
Ct ELISION' 08 - 21 - 2024 0800 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S GRADY WAY BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e RAINIER AVE S
0 1 29
UNIT 01 MOTOOR Z PEDAL ❑ YESAGE NHORE✓LDMET PHONE 0 7 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY '❑- 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 1❑ P1 ATNES# C29136X sTAT WA u N# 5FPYK3F85LB012105
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# Rom ro
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 9 34
13 4 2020 HOND RIDGELI PK DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO VARUN RAWAL 15223 NE 13TH PL APT 1211 BELLEVUE WA 98007 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vEHA"LE CHARGE 5 36
LEcLLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs NO 1/ D:6303633241
16 a
LAST NAME KAMPERSCHROER FIRST NAME LOGAN MIDDLE M
INITIAL
17 STREET❑ NEW ADOREss❑' 13800 NEWCASTLE GOLF CLUB RD APT 303 CITY NEWCASTLE ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTE � 38
INTERLOCK YEs❑NO� INTERLOCK yyEEsl I I NOF YES
t l NO�
19 LICENSE# STATE WA SEX M M D.C.B. 03 _ 24 1993 0 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# BZE9666 TATE 41
WA VIN# 1N4AL2AP9CN532041 4
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
G HI 44
VEH YEAR 2012 MAKE pJ/$$ MODEL AL)'/MA STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ov YES
NO
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 944978750IN IGVEHICLE
TOP
CITATION# CHARGE OTTOM
LEGALLY YES[Z N(E
25❑ s a
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TAGNE 12575 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF07471
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8802
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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
P.LANTAGNE 08-21-24 11:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 8/22/2024 12:31:09 PM
BADGE OR ID# 12575 OR]# WA0171300 TIME POLICE DISPATCHED'; 8:98 AM TIME POLICE ARRIVED',8:19 AM
PART I PAGE IT]OF 4�
DATE AND
TIME
REPORT NO. EF07471 CASE# 24-8802 OF COLLISION08/21/2408:00
NARRATIVE
24-8802
On 08/21/2024 at approximately 0818 hours, I, Officer Lantagne, responded to a hit and run, non-
injury collision report which occurred at the intersection of S Grady Way and Rainier AVE S, which is
located in the City of Renton, County of King, and the State of Washington.
I was contacted by the victim, Logan M. Kamperschroer (DOB 03/24/1993), via phone.
Kamperschroer told me the following: Kamperschroer was driving westbound on S Grady Way.
Kamperschroer stopped at the intersection of Rainier AVE S for traffic and was approximately six
vehicles back from the intersection in lane 3, which had a red traffic signal for traffic continuing onto
SW Grady Way.
As Kamperschroer was waiting for the traffic to clear, the front bumper of Unit#1, a black Honda
Ridgeline with license plates C29136X issued out of Washington State, struck the rear bumper of
Kamperschroer's vehicle, a 2012 Nissan Altima with license plates BZE9666 issued out of
Washington State.
Kamperschroer said there was minor scraping and paint transfer from the collision. The suspect
vehicle backed up and changed lanes to make a left turn but could not leave the scene due to traffic.
Kamperschroer believed the driver was a male but could not provide further description and could not
identify him.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided the report case number to Kamperschroer.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 0952 hours on 08/21/2024 at Renton, WA.
PAGE 3 OF 4
REPORT NO. EF07471 CASE# ' 24-8802 DATE AND TIME 08/21/24 08:00
OF COLLISION
91 5 S ou f s �l
t
u �
t
is
rn,
ssi
PAGE 4 OF 4
