HomeMy WebLinkAbout24-11439 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-11439 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 11 - 1-- 2024 1212 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
WILLIAMS AVE NORTH BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 53 00 FEET e S ❑B W e NORTH 3RD STREET
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4256521905 1 2 30
6� LAST NAME LASSITER FIRSTNAME STEPHEN MIDDLE O 1 1 2 31
INITIAL
STREET ❑ 510 STEVENS AVE SW APT P308 CITY RENTON ST WA 2jp, 980575887 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 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE 6092XF sTArI WAurN# JS3FX92V334106723
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM TO
TRLR. TRLR 9 5 33
12 2 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE $ 34
13 2003 SUZU GV4D SV DAMAGE veS NO 14I� /�TE TOW Es[:] NO
REGISTERED OWNER INFO GERTHA SIMS 510 STEVENS AVE SWAPT P308 RENTON WA 98057 D:4256521905 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 4109-00.65.12 3 4
IN EFFECT &POLICY# 9TOP
vErIICE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4252232488
16 a
LAST NAME K/M FIRST NAME JOHN MIDDLE I S
INITIAL
17❑ STREET ❑', 20484 137TH AVE SE CITY KENT ST WA ZIP 980423001 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 11
19 DRIVER'S STATE WA SEX M D.C... 01 08 _ 1979 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CLY3221 TAre WA VIN# 1HGCT1873FA010983
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2015 MAKE HOND MODEL ACCORD STYLE CP VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24 DAMAGE YES✓ NO PRIVATE TOW YES NO
REGISTERED OWNER INFO JOHN KIM 20484137TH AVE SE KENT WA 98042 D:4252232488 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU&POLICY#E CO SAFECO H2475155IN 1GQ
vE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES Nu
25 s � e
=UGENT
PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 11498 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF37567
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11439
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.
MATTHEW NUGENT 11-07-24 11:22 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1112012024 10:35:27 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 12:16 PM TIME POLICE ARRIVED 12:46 PM
PART I PAGE IT]OF 4�
REPORT NO. EF37567 CASE# 24-11439 OF COLLISION
11/04/24 12:12
OF CbLLI510N
NARRATIVE
24-11439
On 11/04/2024 at approximately 1216 hours, I was dispatched to a non-injury and non-blocking
vehicle collision at the intersection of North 3rd Street and Williams Ave North, within the City Limits
of Renton, County of King, State of Washington.
While en route, Dispatch advised that the collision occurred south of the intersection involving two
vehicles which were on Williams Ave North and waiting for police contact.
Upon my arrival, 1 confirmed there were no complaints of injury at the time of report. There, I collected
the involved parties driving documents and their independent summary of the collision.
The driver of Unit#1 stated that he was the sole occupant of his vehicle and initially parked along the
west shoulder of Williams Ave North, specifically in the 300 block and facing south. The driver of Unit
#1 stated he was intending to enter traffic to proceed southbound onto Williams Ave North. The driver
of Unit#1 checked for other traffic and believed it was clear of hazard therefore proceeded into the
roadway. Upon entering the roadway, Unit#1 was met by Unit#2 which caused moderate damage to
the front driver's side fender and bumper of Unit#1.
The driver of Unit#2 stated that he was the sole occupant of his vehicle and was initially traveling
eastbound on North 3rd Street and then made a southbound turn onto Williams Ave North. The driver
of Unit#2 stated he was intending to proceed southbound onto Williams Ave North. Upon completing
the turn, Unit#1 turned out into the roadway from a parked position. Both Unit#1 and Unit#2 collided
causing moderate damage to the passenger of Unit#2.
Based on the above statements, 1 determined that both of the involved parties had contributing
factors to the cause of collision. Both Unit#1 and Unit#2 were entering the roadway near
simultaneously. Although Unit#2 might have entered the roadway just prior to Unit#1, both vehicles
were attempting to establish right of way on Williams Ave North. I recommended both parties contact
their respective insurance companies for processing.
Both involved vehicles had been moved off of the roadway where their respective drivers made
arrangements for tow/repair. An exchange of information was provided to all involved parties.
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 by Officer M. Nugent#11498 10:54 AM 11/7/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF37567 CASE# ' 24-11439 DATE AND TIME 11/04/24 12:12
OF COLLISION
i
w#
sad
R,
Y
t
ea�'
� \4
PAGE 4 OF 4
