HomeMy WebLinkAbout25-2062 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-2062 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4100 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
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#
cowsloN 03 - 1-- 2025 1549 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
N 3RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ W e W/L!IAMS AVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257577186 0 11
30
6� LAST NAME HUBNER FIRSTNAME ANDREW MIDDLE W 1 2 31
INITIAL
STREET ❑ 2502 NE 5TH PL CITY RENTON ST WA ZIP 980563773 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAUSSY 7 IBA RE OF INJURIES 2❑
3
10❑ pl ATFBit BRY2629 sTAr� WA urN# 1 FM5K8D83FG661033
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 3 0 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 7 $ 34
13 2 2015 FORD EXPLOR DAMAGE vE8 0NO agW�MEYER ves❑ No
REGISTERED OWNER INFO ANDREW HIIBNER 2W2 NE 5TH PL RENTON WA 980563773 D:4257577186 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE 817 442 648
IN EFFECT &POLICY# 9TOP
vEwcLe CHARGE 1 5 36
-ALLY res No CITATION# FAIL TO OBEY TRAFFIC CONTROL o sorrom
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2538311651
16 2
LAST NAME DONOVAN FIRST NAME DANIELLE MIDDLE I L
INITIAL
17❑ STREET ❑', 22021 SE 271ST ST CITY' MAPLE VALLEY ST WA ZIP 980387419 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 DRIVER'S STATE WA ]SEX IF D.C.B. 07 30 _ 1968 0 39
LICENSE# MMDDYY
WELMET INJURY 6 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE CLASS ARMS HEAD ❑
21❑ LICENSE I C20780T TAre WA vIN# 1GCVKREC3FZ333563
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2015 MAKE CHEV MODEL SILVERA STYLE I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO DANIELLE DONOVAN 22021 SE 271ST ST MAPLE VALLEY WA 980387419 D:2538311651 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO GRANGER 5104440058709IN STOP 5
'EwCLE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF71835
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2062
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
PM 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 03-07-25 12:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
M.LEVERTON 2517 31712025 2:25:37 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 3:50 PM TIME POLICE ARRIVED',3:52 PM
PART I PAGE IT]OF 4�
REPORT NO. EF71835 CASE# 25-2062 OF COLLISION
03/05/25 15:49
OF CbLLI510N
NARRATIVE
blk/2 lane 1 eb green brn/1 sb on red
CC
Within the city limits of Renton/King/Wa I responded to 2 vehicle blocking crash at the intersection of
N 3rd St and Williams Ave N.
I contacted the driver of unit 2 who told me he was southbound on Williams ave N on her green light
when unit 1 ran the red light crossing her path with no tome to avoid contact. She did not complain of
injury and damages required a tow truck for heavy front end damage.
I contacted unit 1 ID'd by his picture WADL. He was being treated by Renton Fire for complaints of
injury. He told me he was eastbound N 3rd St, lane 1 and must have missed that his light changed to
red. He said he was suddenly spinning around from the crash. Damages to his vehicle required a
tow truck.
I cited unit 1/Hiibner Ref RCW 46.61.055 FTCWTCD-red light 2 vehicle crash via complaint.
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 3/7/2025
PAGE 3 OF 4
REPORT NO. EF71835 CASE# ' 25-2062 DATE AND TIME 03/05/25 15:49
OF COLLISION
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PAGE 4 OF 4