HomeMy WebLinkAbout25-295 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF58437 170
27
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE# zs-zss 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 7 28
TRIBAL UNITS 03 STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
Ct ELISION' 01 - 09 - 2025 1228 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RENTON AVE EXT BLOCK NO. e✓ 100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 175 00 FMILES EET e S ❑ W e RAINIER AVE S
0 4 29
MOTOR PEDAL- DAMAGETHRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO D:7328740963 0 11
30
6� LAST NAME BLUE FIRSTNAME CARDICAL MIDDLE C 1 2 31
INITIAL
STREET ❑, 1201 S CLOVERDALE ST CITy SEATTLE ST WA 2jp, 98108 2=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER # STATE WA SEX'M MD.
I B Y' 10 - 17 1- 1995 1 2 32
9 ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 HELMET U E 9 CLASS 0 NATURE OF INJURIES 2❑
3
LICENSE CDW5649 STATE WA VIN# 2C3CDZAG5JH229230
10 9❑ Pr ATF�
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. A'RL.R. 1 3 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2018 DODG CHALLE DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO CARDINAL BLUE 1201 S CLOVERDALE ST SEATTLE WA 98108 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE[Z INSURANCE CO GEICO 6142474730 2 3 4
IN EFFECT &POLICY# 9TOP
wLE res CHARGE 5 36
LECAvecIIv ❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2069816705
16 a
LAST NAME GARDUNO MORENO FIRST NAME ELIZABETH MIDDLE N
INITIAL
17 STREET❑ NEW ADOREss❑' 321 F ST SE CITY AUBURN ST WA ZIP 980025508 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 F] D IVEW #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 1
USE CLASS ❑
LICENSE I ❑21❑ PLA E# CLZ4528 TATE 41
WA VIN# 1ZVFT80N755112572 4
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2005 MAKE FORD MODEL MUSTAN STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO ELIZABETH GARDUNOMOREN0321 FSTSE AUBURN WA 980025508 D:2069816705 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 820 823 135IN STOP 5
vewcle ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N J
25 s 7 a
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. EF58437
COLLISION REPORT III III III III III 111
1591972 CASE# 25-295
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 01-10-25 01:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 112212025 11:05:40 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED! 12:28 PM TIME POLICE ARRIVED',12:31 PM
PART I PAGE IT]OF 5�
REPORT NO. EF58437 CASE# 25-295 OF COLLISION
01/09/25 12:28
OF CbLLI510N
NARRATIVE
blk/1 It from am/pm wht/3 Itl wb 2/maroon served to miss 1 hit two over over lap
RTF
Within the city limits of Renton/King/Wa I responded to a 3 car hit and run crash at about the 100
block of Renton Ave Ext.
I contacted the driver of unit 3 who told me he was westbound on Renton Ext when unit 1 made a
sudden left turn from the south driveway AM/PM parking lot towards the left. Unit 3 said as he
crossed traffic unit 2 suddenly swerved to avoid unit 1 and contacted unit 3. He did not complain of
injury and damages did not require a tow truck.
I contacted the driver of unit 2 who told me she was in lane 2 when unit 1 pulled across her lane and
she swerved to avoid unit 1 but contacted unit 3. She did not complain of injury. Damages did
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 1/10/2025
On 1/10/2025 at about 1135 hours 1 was dispatched for a phone follow up reference the above
collision. It was a person who on the phone ID'd themselves verbally as CARDINAL BLUE, the RO
and driver of unit 1. He told me that although he did not contact any vehicles he was feeling "heavy"
about being a witness to a crash.
He told me he was pulling out of the AM/PM and intended on going to the right. However, he noticed
unit 2 at the last minute and stopped immediately. He told me he watched as unit 2 swerved to miss
his vehicle and crash basically head on with unit 3. He said he went left instead of right and drove
away. Unit 1 told me he had never experienced a crash right in front of him and he did not want to be
accused of contributing to a crash without providing his version.
Unit 1 told me he thinks unit 2 was going to fast. I asked him why would he pull out in front of a
speeding vehicle, one he did not initially see because it was clear. I told him both unit 2 and 3 said it
appeared he was making a left and did it quickly in front of unit 2. He said he was making a right.
Unit 2 told me she was in lane 2 so unit 1 would have made an illegal turn into the path of unit 2
(RCW 46.61.290) and it he was making a left turn then hes still in violation (RCW 46.61.205).
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 1/10/2025
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EF558437
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 25-295
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- �`"'j PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO
D:2068598899
0 1 29
LAST NAME ALCANTARA LANUZA FIRST NAME JOSE MIDDLE' A
INITIAL
STREET 30
NEW AnnRFrtP 1213 S LUCILE ST CITY SEATTLE ST WA ZIP 981082333
6
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31
INTERLOCK YEs No NTERLOCK YES[:]NO[:] YES N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 06 - O6 - 1998
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE B74566W [TAT WA VIN# 1FTRE14W64HA260025
PLATE#
9 7] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 3 5 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1C P FROM TO
2004 FORD ECONOLI DAMAGE YES NO YES NO
REGISTERED OWNER INFO GERALD PELLAND 1027 S SAND DUNE AVE SW#2 OCEAN SHORES WA 98569 ] 3 33
12 � SHADE IN DAMAGED AREA
j 4 FROM TO
LIABILITY INSURANCE[] INSURANCE CO
IN EFFECT &POLICY# t 9 1"01?
vewCLE 10 6QTTUM 34
13 ❑ LEGALLY YES❑ NO❑ CITATION# CHARGE
STANDING } 8 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
ET
16 STRETRE "F1' CITY ST ZIP
NEW CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YES NO YEs NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ 39
LICENSE rnr VIN#
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ TRLR TRLR 41
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
Lec E
STANDING 8 7 6
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
X LEVERTON 01-10-25 01:59 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 OI BADGE 2517 O#I',WA0171300 JACOBS 1/22/2025 PAGE F41 OF F
3000-345-013(R 11118)
REPORT NO. EF58437 CASE# 25-295 DATE AND TIME 01/09/2512:28
OF COLLISION
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