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HomeMy WebLinkAbout24-12290 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. EF43960 170
27
COLLISION REP FIT 1591971
SASE 24-12290 2
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&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 11 - 1-- 2024 1328 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON RD S
BLOCK NO. e✓ ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e EAGLE RIDGE DR
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:7734054569 0 11
30
6� LAST NAME SMITH FIRSTNAME HEATHER MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 4285 148TH AVE NE APT I103 CITY BELLEVUE ST WA 2jp, 980078109 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
10 9❑ PI ATE BTS1019 sTArI WAurN# JTKKT624650103278
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T VgyENp/(g GOVT.VEHICLE 5 1 34
13 2 ZOOS TOYT SCION DAMAGE YES NO """- RS YES[:] NO✓
REGISTERED OWNER INFO HEATHERSMITH4285148THAVENEAPTH03 BELLEVUE WA 980078109 D:7734054569 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 9358 821 144
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 4A0765738 FAIL YIELD LEFT TURN MOTOR 1 o aorrom
15❑ STANDING 7 6
MOTOR PEDAL-: PROPERTY DAM THR OLD MET PHONE
UNIT�2 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:4253959712
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME ARNETT FIRST NAME KIMBERLY MIDDLE M
INITIAL
17❑ STREET ❑', 1133 LAKE WASHINGTON BLVD N U F202 CITY RENTON ST WA ZIP 980566488 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs❑NOF YES
❑NO❑
19 LDI IVEW # STATE WA SEX F M DDY
.C... 10 � 1964_ 05 _ El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CNW1127 TAre WA vIN1t 5YF64MDE3PP023024
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN 43
TIN##. IN RLR
' #.
VEH YEAR 2023 MAKE TOYT MODEL COROLL STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO EAN HOLDINGS LLC 14002 E 21ST ST STE 1500 TULSA OK 74134 VEHICLE NO.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 01963 10 32C 7103 0IN 1GQI
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
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. EF43960
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12290
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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'
slv/2 nb wht/1 sb It
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at the intersection
of Benson Rd S at Eagle Ridge Dr.
I contacted the driver of unit 2 who told me she was northbound on Benson Rd S when unit 1 made a
left turn across her path from Eagle Ridge Dr. She did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL. She said, "Its my fault, I turned left and didnt
see the other car." She did not complain of injury and damages did require a tow truck. (Bankers)
I did cite unit 1 ref RCW 46.61.185 FTYROW-Left Turn 2 car collision 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 11/27/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 11-27-24 02:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 12/9/2024 12:43:45 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 1:28 Pry TIME POLICE ARRIVED'1:50 PM
PART I PAGE IT]OF 3�
REPORT NO. EF43960 CASE# ' 24-12290 DATE AND TIME 11/27/24 13:28
OF COLLISION
� s
2
\l a\ t r
�r 1 E
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