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HomeMy WebLinkAbout24-9505 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF14468oc� RA COLLISION REPORT 1591971 CASE# 24-9505 2 INTERSTATE CITY STREET❑ FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER VEHICLE ❑ LOC'AI-ACENC'Y 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 28 TRIBAL UNITS 03 STRUCK BUILDING RESERVATION 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s o v' 09 - 10 - 2024 1249 17 =.= S 8 W e IN OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. RAINIER AVE S 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET e S 8 W e S 7TH ST 0 4 29 MOTOR PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 30 6 LAST NAME BUITRAGO ABRIL FIRST NAME IVAN MIDDLE F 1 0 7 31 INITIAL STREET ] 12118 HIGHWAY 99 APT F401 CITY; EVERETT ST WA ZIP; 982040065 2 NEW ADDRESS 7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'. 3 INTERLOCKYEs No INTERLOCKYEs NO YES NO 8❑ DCIENSE# STATE WA SEXI M MMDDYY' 10 — 12 — 1997 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR CLASSY 14 1 NATURE of INJURIES 2 LICENSE, CLM6108 STATE WA VIN# 2FMTK4J9XFBC07834 3 10 F1 PI ATP tt TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR rRLR 7 1 33 12 VIN#' VIN# FROM TO 13 2 VEH.YEAR2015 MAKE FORD MODEL EDGE STYLE VEHICLE TOYED NO�iS46LIN T�VyED.6LRS GES❑END m 34 DAMAGE IIII._IIII HHttVVii((tt REGISTERED OWNER INFO )VAN BUITRAGO ABRIL 12118 HIGHWAY APT F401 EVERETT WA 982040065 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE[%/] IN&SURANC POLICY#E CO IN EFFECT SRfSTOL WEST GOf 405858800 4 9TOP vEn ' CHARGE t S 36 IALLr yes❑NO❑ CITATION# 70 80TTOM 15❑ STANDING s 7 6 . PROPERTY ✓ R PHONE PDETRIAN O D:42 52284700UNIr 0' VMEOHTIOCRLE CYCLE OWNER 16❑ LAST NAME TOYOTA BRIDGE FIRST NAME BOB MIDDLE' INITIAL STREET ❑ 17 ❑ 650 RAINIER AVE S CITY RENTON ST, WA ZIP 98057 37 NEW ADORE SS 18❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 CDL INTERLOCKYEs No INTERLOGI£YES No YEs No 19 LICENS# STATE SEX U MMDDYY _� 39 20❑ ON DUTY STATUS AIRBAG RESTR EJECT HELMET INJURY NATURE OF INJURIES 40USE CLASS ❑ 21 I LICENSE PLATE# TATE VIN# 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP vemaE ❑ ,.I—I CITATION# CHARGE to BOTTOM EEGnEEY YES NC 25 a s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 M.LEVERTON 2517 WA0171300 PART A PAGE 01 OF 3000-348-189(R 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF14468 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9505 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 INJURY 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 CLASS ----� :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 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. M.LEVERTON 09-10-24 01:37 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 911212024 3:41:05 PM BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 12:51 PM TIME POLICE ARRIVED i 12:57 PM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF F5 REPORT NO. EF14468 CASE# 24-9505 OF DATE AND r�N + 09/10/24 12:49 O�COLLISION NARRATIVE blk into building and hydrant RTF Within the city limits of Renton/King/WA I responded to a car into a building. I arrived and found a black SUV that had yellow paint and damage on the door and front end. There was fresh marks in the beauty bark leading from the tire mark across the sidewalk to the building. I contacted the driver of unit 1 who told me he had a steering issue and wen over the curb hitting both the fire hydrant and building. He did not complain of injury and damages required a tow truck. I contacted the owner of 650 Rainier Ave S (the old Pontiac dealership) which is Bob Bridge Toyota. The GM John North was unavailable but a store employee arrived on scene took photos and received a copy of the information exchange from me. I had Renton Fire respond to check the condition of the hydrant that was hit. The hydrant was knocked clear off its base. Fire advised to contact the water dept at the city. Renton Front Counter contacted the water department for me of the damaged hydrant. Information/Insurance only 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 9/10/2024 PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EF14468POLICE TRAFFIC 1 27 COLLISION REPORT CASE#i 24-9505 t113197 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACARa GWVR NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 PEDESTRIAN YFs No D:4254307400 5 VEHICLE CYCLE OWNER MIDDLE 29 LAST NAME RENTON FIRST NAME ; CITY OF INITIAL STREET CITY 30 NFW AnnRFG 3555 NE 2ND ST RENTON ST WA ZiP gg056 6 CDL GNITION REQUIRED PRESENT MEDICALTANSPORTED. 1 31 I 1{iNi7iON :: INTERLOCK YES NO ':INTERLOCK YES 0N YES N L DRIVER'S STATE SEX U MDDDYBY -�- LICENSE; 7F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NAruREofINJURIES USE CLASS 8 ❑ 1 32 LICENSE TAT VIN. PLATE# L 9 TRAILER TRAILER PLATE# STATE PLATE STATE 0 10 ❑ TRLR TRLR VIN.# VIN#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO DAMAGE YES NO YES NO m 33 REGISTERED OWNER INFO.� SHADE IN DAMAGED AREA 12 LIABILITY INSURANCE❑ INSURANCE CO TP 4 FROM TO IN EFFECT &POLICY# I ""`-" S m 34 13 YES NO[jj CITATION# CHARGE 1080TTOM ecauv sTnNoiNc MOTOR PEDAL_ ' 1:1PROPERTY : DAMAGE THRESHOLD MET PHONE 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 36 15 LAST NAME FIRST NAME IN L 16 ❑ STREET �' CITY ST' ZIP NEW AnDRFS9 CDL IGNITION RE6UIRED IGNITION PRESENT MEDICAL TAN SPORTED INTERLOCK YE5 No INTERLOCK YEs Net YES No ❑ 17 37 LLIICENSE# STATE SEX ,RIVERS - C----� 18 ❑ HELMET 'INJURY NATURE OF INJURIES 38 ON DUTY STATUS' AIRBAG RESTR. EJECT USE CLASS. 19 ❑ ❑ 39 LICENSE TAT vIN# PLATE# 20 TRAILER+ TRAILER 40 PLATE#.: STATE STATE PLATE# - ❑ 21 ❑ TRLR TRLR 41 VIN# VIN#Y 42 22 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO El 23 REGISTERED OWNER INFO. SHADE IN DAMAC ED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT I &POLICY# .. t. E 44 24 YES❑ NO CITATION# CHARGE K-99 SWG 3 3 G 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 09-10-24 01:37 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 BADGE OR ID# 2517 O#RI WA0171300 APJACOBS 9112/2024 PAGE OF � 3000-345-013(R 11t18) IREPORTNO. EF14468 CASE# 24-9505 DATE AND TIME 09/10/2412:49 OF COLLISION> ' rf. t, t <c t < S � � b PAGE 5 OF 5