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Home My WebLink About24-12398 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-12398 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 5 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# ❑ COLLISION.. 12 - 1-— 2024 0429 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ PETROVITSKY BLOCK NO. e✓ 11800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 6❑ 20 00 FEET MILES e S ❑ VV e 118TH 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4257613117 0 11 30 6� LAST NAME WINDSOR FIRSTNAME WILLIAM MIDDLE W 1 1 2 31 INITIAL STREET ❑, 324 AVENUE E CITY SNOHOMISH ST WA Zjp, 98290 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 aTES� C92456X sTArI WAurN# 1FTYR14U56PA05173 11[-j-� TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM ro TRLR. TRLR 7 3 33 12 3 5 VIN#j VIN# :: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34 13 2 2006 FORD RANGE PK DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO WILLIAM WINDSOR 324 AVENUE E SNOHOMISH WA 98290 D:4257613117 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO <53 4 IN EFFECT &POLICY# TOPVEHicLE CHARGE 36 LEGALLvres❑NO CITATION# OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ 16 a OWNER ❑ YES 1/ NO D:2065566956 LAST NAME BURTON FIRST NAME MIALI MIDDLE L INITIAL 17 STREET I❑ 11909 SE 175TH ST#A102 CITY' RENTON ST WA ZIP 98058 37 NEW ADOREss❑' 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVER'S STATE AZ ]SEX IF D.Q.B. 11 01 1998 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 6 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑ 41 21❑ PLATE# CSV9066 TArE AZ VIN# KNADM4A31E6398360 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2014 MAKE KIA MODEL RIO STYLE P4 VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO MIALI BURTON 11909 SE 175TH ST#AI02 RENTON WA 98058 D:2065566956 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU8 PORGY#E CO USAA 0148192 81C 7102 8IN 9TOP 5 --E ❑ ,J� CITATION# CHARGE 25 io BOTTOM LEGALLY YES N J ' e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 MI 11AM LONG 7 12790 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF42892 COLLISION REPORT III III III III III 111 1591972 CASE# 24-12398 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. MIRIAM LONG 12-02-24 08:45 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.WOODWARD 11528 12/6/2024 2:36:37 AM BADGE OR ID# 12790 ORI# WA0171300 TIME POLICE DISPATCHED 4:29 AM TIME POLICE ARRIVED:4:33 AM PART I PAGE IT]OF 4� REPORT NO. EF42892 CASE# 24-12398 OF COLLISION 12/02/24 04:29 OF CbLLI510N NARRATIVE 24-12398 Unless otherwise noted, the following occurred in the City of Renton, County of King, WA. On 12/2/2024 at about 0429 hours 1 responded to a collision at SE Petrovitsky Rd/116th Ave SE. I arrived at the location and observed Unit#1 blocking west bound traffic on SE Petrovitskey Rd with significant front-end damage, including a missing front right wheel. Just west of Unit#1, 1 observed Unit#2, also blocking westbound traffic, with significant damage to the front end of the vehicle. I contacted the involved parties, who were walking around and had no obvious injuries. There, 1 collected the involved parties driving documents and the independent recollection of events leading up to the collision. The driver of Unit#1 (William) said he was the sole occupant of the vehicle and that prior to the collision he was driving east on SE Petrovitsky Rd in lane one. He explained that as he was driving down the hill nearing 118th Ave SE, the back end of his vehicle started to slide out which caused him to lose control and go into westbound traffic, where he collided with Unit#2. The driver of Unit#2 said she was the sole occupant of the vehicle and that prior to the collision she was driving west on SE Petrovitsky Rd in lane one. She said she observed Unit#1, who was driving east on SE Petrovitsky Rd, start to cross the center lane where it then collided with her vehicle just west of 118th Ave SE. Two independent witnesses, verbally identified as Keith Lederer (DOB 6/4/1986), and Jennifer M Ocampo Melendez (DOB 9/25/1995), remained at the scene. Both witnesses confirmed the above statements claiming they observed Unit#1 sliding sideways as it proceeded eastbound on SE Petrovitsky Rd into oncoming traffic, striking Unit#2 who was driving westbound on SE Petrovitsky Rd, in lane one. The driver of Unit#1 (William) advised he did not have insurance at the time of the collision. All involved parties exchanged information and were provided the case number. Renton Fire Department responded to the location and evaluated the driver of Unit#2 as a precautionary due to airbag deployment. I took photos of all the involved vehicle's and uploaded them to Axon. Both Unit's required a tow due to the fact that they were blocking the roadway and had extensive damage. Bankers Towing responded to the location and privately towed both vehicles. I gave the driver of Unit#1 a verbal warning for violating RCW 46.30.020 which states that no person may operate a motor vehicle subject to registration under chapter 46.16A RCW in this state unless the person is insured under a motor vehicle liability policy with liability limits of at least the amounts provided in RCW 46.29.090, is self-insured as provided in RCW 46.29.630, is covered by a certificate of deposit in conformance with RCW 46.29.550, or is covered by a liability bond of at least the amounts provided in RCW 46.29.090. Proof of financial responsibility for motor vehicle operation must be provided on the request of a law enforcement officer in the format specified under RCW 46.30.030. My involvement in this case was captured on my department-issued Axon body camera. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Electronically signed by M Long#12790 on 12/2/2024 @ 0700 hours in Renton WA. PAGE 3 OF 4 REPORT NO. EF42892 CASE# 24-12398 DATE AND TIME 12/02/24 04:29 OF COLLISION r I, v�t I <t, l' ty I i t} � t v S t 3 � i �4tk M' z t I1� ( Y� n tttt��£ it f 41, 4 . PAGE 4 OF 4