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HomeMy WebLinkAbout24-10936 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-10936 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4150 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 28 TRIBAL UNITS 02 STRUCK NONE RESERVATION z 3❑ DATE OF; M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION.. 10 - 1-— 2024 1818 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S 192ND ST BLOCK NO. e✓ 9800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 50 00 FEET MILES e S ❑ W e 98TH AVE S 0 1 29 UNIT 01 MOTOR CYCLE ❑ YES ]NO MET PHONE 0 1 30 6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31 INITIAL STREET ❑ CITY ST ZIP z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCK YES NO YES No 8❑ LIRCIENSRE# STATE I SEX u MMDDYY - 1 1 2 32 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑ 3 10 9❑ P1 AT 14 BOS5948 STATE WA VIN# 19XFA165X9E031115 11[-jTRAILER STAE TRAILER STATE 11 0 0 PLATE# PLATE# FR.. ro TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 4 2009 HOND CIVIC 4D DAMAGE YES NO YES ❑ NO✓ REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEHICe CHARGE 1 5 36 LEGALLY YES❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066120316 16 a LAST NAME MADJA FIRST NAME ISIAH MIDDLE K INITIAL 17 STREET I03RD AVE SE CITY COVINGTON ST WA ZIP 98042 37 NEW ADDREs�' 25914 2 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED 38 INTERLOCKYES�NOR INTERLOCK yEs It I NOF YES t l NO❑ 19� DRIVER'S STATE WA SEX M D.C.B. 03 29 _ 1998 0 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 HE 2 INJURY 6 NATURE OF INJURIES 40 USE CLASS WHIPLASH LICENSE I ❑21❑ PLA E# CBK8376 TATE 41 WA VIN# 5YJ3E1EBXNF138815 4 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. G HI 44 VEH YEAR 2023 MAKE TESL MODEL MODEl3 STYLE 4D DAMAGE TOWED NOO✓ BLIN TOWED BY ov YES NO 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO PROGRESSIVE 954463554IN 1 9TOP 5 VEHICLE YES[:] N C[:] CITATION# CHARGE i o BOTTOM LEGALLY 25 $ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEITH PETTY 12809 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF36937 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10936 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. KEITH PETTY 10-21-24 03:31 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.TRADER 4553 1111812024 7:47:28 PM BADGE OR ID# 12809 OR]# WA0171300 TIME POLICE DISPATCHED 6:27 Pry] TIME POLICE ARRIVED',6:32 PM PART I PAGE IT]OF 4� REPORT NO. EF36937 CASE# 24-10936 OF COLLISION 10/20/24 18:18 OF CbLLI510N NARRATIVE 24-10936 On 10/20/2024 at approximately 1818 hours I was working for the city of Renton as a police officer. I was dispatched to the intersection of 98th Ave S and S 192nd St in the City of Renton County of King State of Washington for hit and run report. Upon arrival I contacted the registered owner Isiah Keith Alvarez Madeja (DOB 03/29/1998) identified by his WADL. Isiah stated that he was driving gray Tesla Model 3 (CBK8376/WA) VIN/5YJ3E1 EBXNF138815 heading east on S 192nd St near the 98th Ave S intersection, when a gray 2009 Honda Civic (BOS5948/WA) had been traveling west on 192nd ST. The Honda turned to sharp into the curve and collided into Isiah's vehicle causing over $1000 worth of damage to the driver's side rear door, and rear wheel. The Honda had damage to the front driver's side fender. The Honda was occupied by three individuals aged from late teens to early twenties. The driver was a black male with black curly hair, the front passenger was a white female with blond hair wearing glasses, and the rear passenger was a white male with a buzz cut. Isiah stated that he felt like he was experiencing some whiplash and was going to go get medically checked. I sent Isiah a link where he upload the photos of the damage. Isiah also stated he viewed the suspect vehicle stop in a driveway at 9119 S 192nd St where he observed a camera pointed at the driveway. I was unable to reach the residence for review of the camera. This incident was captured on my body worn camera. This report is a summary of the events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. "I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct." Electronically signed: K.Petty, Date: 10/20/24 at 2024 hours, Place: Renton, King County, WA PAGE 3 OF 4 REPORT NO. EF36937 CASE# ' 24-10936 DATE AND TIME 10/20/24 18:18 OF COLLISION t F � u I I 4 �z Mdp Y 41 u 4`Pr P t t� #� Y I f tt„ t t i c s a. i, PAGE 4 OF 4