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HomeMy WebLinkAbout24-12112 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. EF39417 170 27 COLLISION REP FIT 1591971 CASE 24-12112 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� Ell 28 TOTAL#OF OBJECT TRIBAL UNITS 02 STRUCK OVER EMBANKMENT RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION.. 11 — 22 — 2024 1416 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RENTON AVE EXT BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e HAYES PL SW 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2069152095 0 11 30 6� LAST NAME ELLIS FIRSTNAME TISELL MIDDLE I D 1 2 31 INITIAL STREET ❑ 4614 48TH AVE S CITY SEATTLE ST WA ZIP 981181456 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 10 9❑ PI ATFBit BZP1094 sTArI WA VIN#' JTHBD182710022716 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR. TRLR 3 5 33 12 3 5 VIN#' VIN#' ROM TO VEH.YEAR 2001 MAKE LEXS MODEL IS STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 2 DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO MICHAELSUDDUTH 602 HOQUTAMAVENE RENTON WA 98059 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO 4 IN EFFECT &POLICY# 9TOP ve 36 'CLE CHARGE 5 LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM 15❑ NDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ 16 a OWNER ❑ YES 1/ NO D:2066020143 LAST NAME GARCIA-CHAVEZ FIRST NAME MICHELLE MIDDLE I M INITIAL 17❑ STREET ❑', 51 HAYES PL SW APT 304 CITY' RENTON ST WA ZIP 980575950 37 NEW ADDRESS ❑ 18E CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED ❑ 38 INTERLOCKYES — NOR INTERLOCK YEs I I NOF YES t l NO❑ 19 D IVEW # I {NJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21❑ LICENSE I CFD2969 TAre WA VIN1t JTLZE4FE2CJ005478 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR 2012 MAKE TOYT MODEL SCION X$ STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI �44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO JAYRON GARCIA NAVAS 2416 S 224TH STAPT 104 DES MOINES WA 98198 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE I POLICY#E CO SAFECO H2464784IN 9TOP 5 VE""LE ❑ Nu,J CITATION# CHARGE LEGAL to BOTTOM LY YES 25 ' e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 M.LEVERTON 2517 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF39417 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12112 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 11-22-24 03:00 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT C.JACOBS 1953 1112512024 12:07:34 PM BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED; 2:97 Pry TIME POLICE ARRIVED i 2:27 Pry PART I PAGE IT]OF 4� REPORT NO. EF39417 CASE# 24-12112 OF COLLISION 11/22/24 14:16 OF CbLLI510N NARRATIVE slv/1 It 3 lanes plum cube eb lane 1 for mcd RTF Within the city limits of Renton/King/WA I responded to a 2 vehicle blocking crash at the intersection of Renton Ave Ext at Hayes PI SW. I contacted the driver of unit 2 who told me she was westbound with the intention of crossing over the small media while passing traffic to enter into the McDonald's parking lot when unit 1 crossed her path and making contact. She veered over the sidewalk, over a small embankment and into the bushes and grass near the McDonald's parking lot. She did not complain of injury and a tow truck was required to recover her vehicle from over the embankment. I contacted the driver of unit 1 who told me traffic had stopped westbound in both lanes 2 and 3. He was attempting a slow left turn across the stopped lanes of traffic when unit 2 was blocked from sight in lane 1 by other traffic where they made contact. Unit 1 did not complain of injury and damages did not require a tow truck. Unit 1 was making a left turn across traffic with one of three lanes obstructed by other traffic. Unit 2 was utilizing lane 1, but with the intention of disregarding the right turn only and crossing the median/barrier to McDonald's. This will be for information/insurance only. 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 11/22/2024 PAGE 3 OF 4 REPORT NO. EF39417 CASE# ' 24-12112 DATE AND TIME 11/22/24 14:16 OF COLLISION Y jg ` 4 (t } �1r1 � e 01 PAGE 4 OF 4