HomeMy WebLinkAbout24-9998 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
SAS 24-9998 2
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
Ct ELISION' 09 - 1-- 2024 0600 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 30TH ST BLOCK NO. e✓ 1500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e I-405
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2533911197 0 81
30
6 LAST NAME AGUERO MEDRANO FIRST NAME RAMON MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 13324 31ST AVE S CITY SEATTLE ST WA 2jp, 981683956 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 2❑ P1 ATNES14 ZJX077A STATE MX VIN# 5TFEM5FMEX077816
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# Rom ro
TRLR. 1`RLR 5 7 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE J 9 34
13 2 2014 TOYT TUNDR DAMAGE vEs 0NO agW�MEYER vEs❑ No
REGISTERED OWNER INFO RAMON AGUERO MEDRANO 1332431ST AVE S SEATTLE WA 981683956 D:2533911197 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO HD1580-12159.1 3 4
IN EFFECT &POLICY# Q�,Q,
VE— CHARGE 36
LEGALLY YES❑NO CITATION# 4A0652684 FLD TO DRIVE ON RIGHT SIDE OF 15❑ STANDING
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:9723021054
16 a
LAST NAME VEGA MEADOWS FIRST NAME SHAMIRA MIDDLE I S
INITIAL
17❑ STREET ❑', 24245 13TH PL S CITY' DES MOINES ST WA ZIP 981987808 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES
t l NO❑
19[ LDI IVER # STATE WA SEX IF M DDY
D.O.B.
05 _ 05 _ 1984 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CMP7227 TATe WA VIN# 1FA6P8TH2P5109343
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2023 MAKE FORD MODEL MUSTAN STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO SHAMIRA VEGA MEADOWS 2424513TH PL S DES MOINES WA 981987808 D:9723021054 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO DIRECT 2024873955IN STOP 5
VE""LE CITATION# CHARGE LEG i o BOTTOM
ALLY YES NEI 6
25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF18314
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9998
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.
M.LEVERTON 09-24-24 09:53 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 9/24/2024 10:15:57 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 6:01 AM TIME POLICE ARRIVED',6:14 AM
PART I PAGE IT]OF 4�
E AND
REPORT NO. EF18314 CASE# 24-9998 OF COLLISION 09/24/24 06:00
OF COLLISION
NARRATIVE
slv/2 Itl/stop blu trk
CC
Within the city limits of Renton/King/WA I responded to a 2 vehicle blocking crash at NE 30th above I-
405.
When I arrived unit 2 was in the eastbound left turn lane to go north onto 405. Unit 1 was at unit 1
front bumper not quite in the middle of the headlights.
I contacted the driver of unit 2 who told me she was stopped in the left turn lane to proceed
northbound when unit 1 made a left turn from the northbound off ramp of 405 and drove into the front
of her car. She did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. He told me he was making a left from the off
ramp, did not see unit 2 and crashed into the front of her car. He did not complain of injury and
damages required a tow truck.
I cited unit 1 via complaint ref RCW 46.61.100, driving left of center.
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 9/24/2024
PAGE 3 OF 4
REPORT NO.! EF18314 CASE# 24-9998 DATE AND TIME 09/24/24 06:00
OF COLLISION
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PAGE 4 OF 4
