HomeMy WebLinkAbout25-760 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF67173OLCERA
COLLISION REPORT 1591971
❑ 0 RESULTED I
$ 25-760 z
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOL`CODICENC'Y 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 01 - 24 - 2025 0947 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
108TH AVE SE
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e SE 187TH PL
0 9 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES V/NO 0 1 30
6 LAST NAME DEO FIRST NAME KRISHNA MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 13816 SE 275TH PL CITY; KENT ST WA ZIP; 980429046 2
NEW ADDRESS
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ND INTERLOCKVEs NO YES F NO
8 DRIVER' # STATE WA SEX M MMD4YY' 12 - 25 - 1973 t 1 2 32
9 ON DUTY STATUS' AIRBAG 3 RESTR 4 EJECT 1 HELM USE SS ETLAINJURY 7 LEG NATURE OF INJURIES 2
LICENSE, C92168S srATs WA VIN#; 1FTER4FH1KLB09312 3
10 Fq I PI ATP rt
TRAILER STATE TRAILER STATE ROM TO 11 4 0 PLATE# PLATE#
TRLR zRLR 9 9 33
12 4 Q VIN#' VIN#
FROM TO
13 2 VEH.YEAR2019 MAKE FORD MODEL RANGE STYLE VEHICLE TOYED NO�iS46LIN T�VyED.6LRS GES❑END 5 1 34
DAMAGE IIII._IIII HHttVVii((tt
REGISTERED OWNER INFO KRISHNA DE013816 SE 275TH PL KENT WA 980429046 VEHICLE RED 1
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 2 3
14 ST FARM 511 7775-C17-47
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t 36
Lemur yes❑NO� CITATION# 7 0 80TTOM
15❑ sTnNowc s 7
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES f/ NO D:2535762826
16�
LAST NAME RELERFORD FIRST NAME MYLIANA MIDDLE L
INITIAL
STREET ❑ 37
17� ❑ 2620193RDSTREETCTE CITY' SPANAWAY ST, WA ZIP 983873405
NEW ADDRESS
18❑ CDL IGNITION REQUIRBD IGNITION I PRESENT MEDICAL TRANSPORTED' 38
INTERLOCK YES Nb INTERLOCK YES N.Fj YES NO
19 DRIVER'S STATE WA SEX F D.Os. 03 07 1996 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE CLASS 1 ❑
LICENSEI
21 PLATE# CJC1696 rare WA vIN# 5XYKUDA21 BG077932 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN It 'IN It
TOWED BY GOV HI 44
VEH,YEAR 2011 MAKE /p�Q MODEL SORENT STYLE VEHICLE
TOWED�/ No BLIN BANKERS
24
REGISTERED OWNER INFO MYLIANA RELERFORD 2620193RD STREET CT E SPANAWAY WA 983873405 D:2535762826 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO GEIC04298-78.95.08
IN EFFECT &POLICY# Q
VEHICLE ❑ J—I CITATION11 CHARGE70L'EILY YES N25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF67173
COLLISION REPORT III III III III III 111
1591972 CASE# 25-760
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
POS. ' USE GLASS 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 CIASS ----�
: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 GLASS
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 01-24-25 10:58 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
C.JACOBS 1953 2/19/2025 1:42:39 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 9:47 AM TIME POLICE ARRIVED i 9:56 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF67173 CASE# 25-760 O OF COLLI 510N TIME 01/24/25 09:47
COLLISION
NARRATIVE
gry/1 stopped for bus opposing side biege 2 rear
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at the intersection
of 108th Ave SE at SE 187th Pl.
I contacted the driver of unit 1 who told me he was northbound 108th Ave SE lane 2 when he stopped
for a bus with is paddle out when he was rear-ended by unit 2. He was checked and released by
Renton Fire. His vehicle required a tow truck for damages.
I contacted the driver of unit 2. She told me she was behind unit 1 when he suddenly/rapidly stopped
for a school bus stopping on the south side of 108th Ave SE. She was unable to avoid this
unwarranted stop. She did not complain of injury and damages required a tow truck for damages.
The roadway at 108th Ave SE and SE 187th PI is 5 lanes 2 northbound 2 southbound with a
2WCLTL. There is no requirement for a northbound driver to stop for a southbound bus/stop. Ref
RCW 46.61.370
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 1/24/2025
PAGE 3 OF 4
REPORT NO. E F67173 CASE# 25-760 DATE AND TIME 01/24/25 09:47
OF COLLISION> '
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