HomeMy WebLinkAbout24-9519 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-9519 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 2$ TRIBAL UNITS 02 STRUCK M/SC OBJECT OR DEBRIS ON ROAD RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION.. O9 - 10 - 2024 2118 17 �. S 8 W H OF 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❑ ❑ FEET e S ❑ W e W/L!IAMS AVE S 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:2066692928 0 11 30 6� LAST NAME LEI FIRSTNAME YUWEN MIDDLE 1 2 31 INITIAL STREET ❑✓ 525 UNION AVE NE CITY RENTON ST WA ZIP 98059 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES No�/ 8❑ DRIVERS # STATE WA SEX'M I D-MIDI Y' 10 - 01 - 1961 1 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ PI ATNE 14 CBt2406 sTAr WAvN# 2HKRL1860XH544105 TRAILER STATE PLAILER T# 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 T GOVT.VEHICLE 1 $ 34 13 1 1999 HOND ODYSSE VN DAMAGE YES NO �AWkkRS YES❑ No REGISTERED OWNER INFO YUWEN LEI 525 UNION AVE NE RENTON WA 98059 D:2066692928 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE U INSURANCE CO PROGRESSIVE 973557839 IN EFFECT &POLICY# STOP VEr�ICLE 5 36 LEGALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252466240 16 a LAST NAME ADAMSKI FIRST NAME MARGARET MIDDLE IT INITIAL 17 STREET I❑ 5❑' 434 PELLEYAVE N CITY RENTON ST WA ZIP 98057 4❑ 37 NEW ADORE5 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YES t l NO� 19 D IVERI # STATE WA SEX F M.C... 11 � 30 _ 1961 39 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40 ❑ILICENSE 21❑ PLA E# AAR4233 TArE 41 WA VINE 2FAFP74W12X150948 1 42 22 R TILER❑ PLATILER E# STATE PLATE# STATE 23❑ TRLR R 43 LR VIN#. N I #. VEH YEAR 2002 MAKE FORD MODEL CROWN STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO MARGARET ADAMSKI 434 PELLEY AVE N RENTON WA 98057 D:4252466240 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO NA NA STOP 5 VEHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM LEGALLY YES N 25 a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# [ZoNCY 26 KEV/N PETERSON 12808 171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF16911 COLLISION REPORT III III III III III 111 1591972 CASE# 24-9519 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 09/10/24 at 2120 hours at S 2nd St and Williams Ave S, in city Renton, King County WA. Unit 1 CBL2406 Driver: Yuwen Lei (DOB 10/01/1961) Unit 2 AAR4233 Driver: Margaret T. Adamski (DOB 11/30/1961) Unit 1 was traveling West on S 2nd St approaching the intersection of Williams Ave S when he said he went into the intersection on a yellow light and then got into an accident. Unit 1 stated he was in lane 1 when he was hit. Unit 2 was traveling South on Williams Ave S when approaching S 2nd St and stated when she drove into the intersection, she was hit by Unit 1. The damage on Unit 1 is consistent with his story of going threw the yellow light and being t boned by Unit 2. Both drivers were seen by fire and stated no injuries. Upon request Adamski was unable to provide proof of insurance that was valid and was cited for driving a motor vehicle without insurance. Adamski had a driver's license that was suspended or revoked in the third degree and was cited for driving a vehicle while his license was suspended. Adamski failed to register her vehicle and was cited for expired registration over 2 months. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 09/11/2024, 0014 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 09-11-24 12:33 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 9/21/2024 5:44:46 AM BADGE OR ID# 12808 OR]# WA0171300 TIME POLICE DISPATCHED 9:20 PM TIME POLICE ARRIVED:9:22 PM PART I PAGE IT]OF REPORT NO.! EF16911 CASE# ' 24-9519 DATE AND TIME 09/10/24 21:18 OF COLLISION d� 00 06 a.K Yu r. i � 4 1 PAGE 3 OF 3