HomeMy WebLinkAbout24-12723 ("7—
STATE.w,-" .:.. TFFiN27CERAc REPORT NO. EF46248
,one COLLISION REP F 1591971
CASE# 24-12723 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coAT sloN 12 - 11 - 2024 1831 17 a. S e W 8 IN
OF 8 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAWER AVE S
BLOCK 8✓ .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET e✓ S e W 8 S 2ND ST
0 1 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
����0 vEHicLE cvcLe YES ,/No D:2065526113 0 8 30
6 LAST NAME WILBUR FIRST NAME KIM MIDDLE' M [; 2 31
INITIAL
STREET E:1 11824 SE 261 ST PL CITY KENT WA
NEW ADDRESS S7 ZIP 980308410 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YEs No,/ INTERLOCKYEs NOW YES NO,/
8❑ LICENSE STATE WA SEX'F MM flYY 10 - 17 - 1965 1 0 1 32
9 ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H L E7 2INJURY
CLASS1 NATURE OF INJURIES 2
10 1❑ ucENSPI ATF#, BEN1591 srArE WA WIN# JA4JT5AX1C0007759 3
11 3 5 STATE PLATE# STATE FROM To
TRAILER TRAILER
PLATE#
TRLR TRLR. 1 5 33
12 3 5 VIN#' VIN#
FROM TO
13 4 VEH.YEAR2012 MAKE MITS MODEL 00TLAN STYLE UT VEHICLE TOWED 2NOffBLIN 9NED.4LRS GOVT,VENOCL✓ g 9 34
❑ DAMAGE IIII_JIII tlAlVt(t ccJllu—'II
REGISTERED OWNER INFO KIM WILBUR 11824 SE 261ST PL KENT WA 980308410 D:2065526113 VEHICLE NO. 1 ❑
SHADE 1N DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 4
14 STATE FARM 128 6563-COS-47EIN EFFECT &POLICY#vt FFIE CHARGE36
EG Y YES❑NO❑ CITATION# <,�Q
1 S❑ srAnomc 7 6
MOTOR PEDAL: 0 PROPERTY DAM THR OLD MET PHONE
PEOESTRIAN
UNIT 02 VEHICLE CYCLE OWNER YES V NO D:2062291329
16�
LAST NAME MCDANIEL FIRST NAME NICOLE MIDDLE G
INITIAL
17 F1 STREET El 24308 237TH WAY SE CITY' MAPLE VALLEY ST', WA ZIP 980385272 1 4
NEW ADDRESS ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION pRESEIJT MEDfCALTRANSPORTED 38
W7ERLOCKves No INTERLOCkCvEs no ves NO,�
19 DRIVER'#
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 IHELM
USEE7 2 CLASS 1 NATURE OF INJURIES 40
❑21❑ LICENSE AZV8063 TATE'W 41
A v)N# 2FMTK4J86FBB57215 1
PLATE#
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. '[N#,
VEH.YEAR 2015 MAKE FORD MODEL EDGE STYLE UT DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
YES O
24
REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2
SHADE IN DAMAGAREA
LIABILITY INSURANCE INSURANCECO STATE FARM L240530-BO8-47H 2 3
IN EFFECT &POLICY# t 4TOP
VEHICLE � 1— CITATION# CHARGE
25 tOBOTTQM
LEGALLY YES NC[:]
B 7
7KEN
'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
PETERSON 12808 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF46248
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12723
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. I USE CLASS
NARRATIVE
I was dispatched to a collision on 12/11/24 at 1833 hours at 261 Rainer Ave S, in city Renton, King
County WA.
Unit 1 BEN1591 Driver: Kim M. Wilbur (DOB 10/17/1965)
Unit 2 AZV8063 Driver: Nicole G. McDaniel (DOB 09/26/1971)
Unit 2 was stopped in traffic for a traffic light when she suddenly was hit from behind by Unit 1. Unit 1
told me that she thinks because the dark color of the vehicle she did not see it in time and by time she
braked did not have enough space to stop. Unit 2 stated that she taped a vehicle that was in front of
her, but they pulled over and looked at vehicles then left. Unit 2 had no frontend damage to the
vehicle.
Drivers stated that there were no injuries.
The drivers were given a case# as reference.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 12/11/2024, 2249 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 12-11-24 10:51 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 12/15/2024 7:51:36 PM
BADGE OR ID# 12808 ORI#' i WA0171300 TIME POLICE DISPATCHED 1 6:33 PM TIME POLICE ARRIVED i 6:37 PM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F3
REPORT NO. EF46248 CASE# 24-12723 DATE AND TIME 12/11/2418:31
OF COLLISION
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