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HomeMy WebLinkAbout24-9508 iiTFi " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF14469oc� RA COLLISION REPORT 1591971 CASE# 24-9508 2 INTERSTATE CITY STREET FIRE I RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LQCCOAGENCY 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E eDLLISION' 09 - 10 - 2024 1417 17 =.= S 8 W E IN M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION BLO❑ BRONSON WAY N MILE POST e 1400 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET e S 8 W e MEADOW AVE N 0 4 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2538448144 0 1 30 5 LAST NAME ELLIS FIRST NAME CHLOE MIDDLE L 1 1 2 31 INITIAL STREET ] 15030 SE 179TH ST#18-A CITY; RENTON I ST WA ZIP; 98058 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO INTERLOCKVEs Np YES NO 8❑ LCEENSE# SRVERSTTATE SEXI U MMDDYY' —=— 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELM U SET LASSY 7 HEADE OF INJURIES 2 LICENSE, CCN8681 STATE WA y WDBJF65HOXA779407 3 10� as ATP tt IN# TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# 11ROM To TRLR zRLR 1 3 33 12 2 5 VIN#' VIN# FROM TO HICLE 13 2 VEH.YEAR 1999 MAKE MERZ MODEL E320 STYLE VEHICLE TO YED NO jyS46LIN diW9YMEYER YESr`-IVT ENp 3 7 34 DAMAGE IIII._IIII I_I REGISTERED OWNER INFO EUGINE RHEE 17205 SE JONES RD RENTON WA 98058 D:2538448144 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 3 4 14 2 LIABILITY INSURANCE ElNSURANCE CO IN EFFECT &POLICY# 4TOP VEn" CHARGE 10 BOTTOM 5 36 15 Lrn Lyc yes❑NO❑ CITATION# 4A0652647,4A0652647, FA►L YIELD PRIVATE RD MOTOR $ 7 UNIT 02 MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE VEHICLE CYCLE nWNRR 16� LAST NAME BELALA FIRST NAME ' RONALD MIDDLE' INITIAL 17 F1 STREET ❑❑ 5118 NE 3RD ST CITY RENTON ST, yyq ZIP 980594961 37 NEW ADDRESS 18❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38 CDL INTERLOCKYEs No INTERLOGKYES No YES NO 19 DRIVER'S STATE WA SEX M D.O.B. 07 15 1935 39 LICENSE# MMIlDYY — HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICEN LATE# B52430T rare W/a vIN# 3D3KA26C94G115739 41 22❑ STATE PLAAILER TE# STATE 42 PLATE# 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2004 MAKE DODO' MODEL RAMPU STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO REGISTERED OWNER INFO RON BELALA 5118 NE 3RD ST RENTON WA 98059 D:4252716313 VEHICLE NO.2 SHADE DAMAGED AREA 3 4 LIABILITY INSURANCE INSURANCE CO SAME. IN EFFECT &POLICY# 9TOP vewaE ❑ ,J—I CITATION# CHARGE i060TTOM LE—LY YES N`.L J 25a 7'OFFLIl'tER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 VERTON 2517 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF14469 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9508 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 GLASS 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 CIASS ----� :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 GLASS 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 03:20 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED APPROVED BY DATE C.JACOBS 1953 911212024 3:40:16 PM BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:18 Pry] TIME POLICE ARRIVED i 2:21 PM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4 REPORT NO. EF14469 CASE# 24-9508 OF DATE AND r�N + 09/10/24 14:17 O�COLLISION NARRATIVE blk sedan It from bigfoot across lane two hit unit 2 maroon trk i was waved out dwls no ins CC On 9/10/2024 at about 1417 hours 1 responded to a 2 vehicle blocking crash at the 1400 block of Bronson Way N at Meadow Ave N. I contacted the driver of unit 2 who told me he was west in lane 2 on Bronson Way N when unit 1 drove across his lane. He said there was not time to react. He did not complain of injury and damages did not require a tow truck. I contacted the driver unit 1 ID'd by her picture WADL as Ellis, Chloe Love 02142002. She kept saying she didnt want to be in trouble and that a driver waved her out across lane one. She was holding her head and 1 requested for Fire to respond. They checked and released her on scene. She told me she was attempting to make a left out of the parking lot and another driver stopped to let her out, but she did not see unit 2 when she crashed into him. She was unable to provide valid proof of insurance for her car. A WACIC/DOL check via Dispatch revealed Unit 1/Ellis was Driving While License Suspended 3rd Degree. She acknowledged this after telling me that she was licensed when she actually wasnt. Damages required a tow truck. I cited unit 1/Ellis Ref RCW 46.61.205 FTYROW from private drive 2 vehicle crash, Ref RCW 46.30.020 No valid proof of insurance via complaint. 1 cited Ellis via the Renton Prosecutors office ref RCW 46.20.341 DWLS 3rd . 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 4 IREPORTNO. EF14469 CASE# 24-9508 DATE AND TIME 09/10/2414:17 OF COLLISION a PAGE 4 OF 4