HomeMy WebLinkAbout25-219 a POLICETRAFFic" II I f I) 1 Ilf I I ('I I (Illf If( f I I REPORT NO. EF54043 0 7 27
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE 25-219 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 01 - 1-- 2025 1357 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e MEADOW AVE N
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:2064577775 0 7 30
6� LAST NAME WATERS FIRSTNAME JALEN MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 2517 MILL AVE S CITY RENTON ST WA ZIP 980554360 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]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 2❑
3
10 9❑ Pi aT�S� D56737D sTATe WAurN# 3FTTW8F96PRA69043
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2023 FORD MAVERI DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO 1A1ENWATERS425169THSTS SPANAWAYWA98387 D:2064577775 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO DIRECT 2024904298 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ LEGALLY STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:5097316648
16 2
LAST NAME DE LA GARZA FIRST NAME ANGEL MIDDLE A
INITIAL
17❑ STREET ❑', 201 SOUTHERN AVE APT 1 CITY' SELAH ST WA ZIP 989421681 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 07 28 _ 1998 0 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CGX7512 TATE WA VIN# JTEHF21A130099240
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2008 MAKE TOYT MODEL HIGHLAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO ANGEL DE LA GARZA 201 SOUTHERN AVE APT I SELAHWA989421681 D:5097316648 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 965638893IN 1 9TOP 5
VE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES Nu
25❑ J s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF54043
COLLISION REPORT III III III III III 111
1591972 CASE# 25-219
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 01-07-25 03:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 11812025 9:31:02 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 4:89 Pry TIME POLICE ARRIVED',Y:03 PM
PART I PAGE IT]OF 4�
REPORT NO. EF54043 CASE# 25-219 OF COLLISION
01/07/25 13:57
OF CbLLI510N
NARRATIVE
beige/2 lane 1 stop gray/1 rear
RTF
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Bronson Way N at Meadow Ave N.
Renton Fire was already on scene. They told me unit 2 was more shook up than anything.
I contacted the driver of unit 2 who told me he was stopped for traffic when he was hit from behind by
unit 1. After he was checked by Fire he remained seated in his truck. Damages did not require a tow
truck.
I contacted the driver of unit 1 who told me he wasnt paying close enough attention to realize unit 2
was stopped in lane one. He did not complain of injury and damages did not require a tow truck.
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 1/7/2025
PAGE 3 OF 4
REPORT NO. EF54043 CASE# 25-219 DATE AND TIME 01/07/2513:57
OF COLLISION
11
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PAGE 4 OF 4