HomeMy WebLinkAbout25-1404 IT �i " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF68534OLCERA
COLLISION REPORT 1591971
CASE# 25-1404 2
INTERSTATE CITY STREET FIRE I
RESULTED
STOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TRIBAL i UNITS TRUCK
#OF 02 SO"" CONCRETE/JERSEY BARRIER 1 1 8 28
i RESERVATION : 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E
eOL�ISION' 02 - 13 - 2025 0817 17 �.�� S W OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOMAPLE VALLEY HWY MILE POST
e 2500 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
6 7501.1 00 FEET e✓ S 8 W e BLAINE DR SE
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4258983050 0 1 30
6 LAST NAME BURGHART FIRST NAME LUKE MIDDLE J 1 2 31
INITIAL
STREET ❑ 23515 LINDA LN CITY, MONROE ST WA ZIP 982729412 2
NEW ADDRESS
7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERLOCKVEe No YES NOD
8 DCIENSE# STATE WA SEXI M MMDDYY' O6 - 19 - 2007 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
LICENSE, CLM2596 STATE WA VIN#; JFlSF655XXH726108 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM To
TRLR TRLR 7 3 33
12 4 Q UIN#' VIN#
FROM TO
13 2 VEH.YEAR 1999 MAKE SUBA MODEL FOREST STYLE DAMAGE TOWED NO�iS46LIN Tv49WEBYMEYER GO NO VT,VEHICLE 7 3 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO gMANDA BURGHART 235f5 LINDA LN MONROE WA 98272 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE� INSURANCE CO SAME. 4
IN EFFECT &POLICY# 4TOP
V""' CHARGE 5 36
LE,,ALLY YES❑NO❑ CITATION# 70 80TTOM
15❑ STM ING 7
UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM OLD MET PHONE
1 VEHiC1.E CYCLE nWNFR YES� THR/ NO
16�
LAST NAME TRUFANT FIRST NAME MARCUS MIDDLE L
INITIAL
17 F1 STREET ❑❑ 37 209 NORTHSIDE RD CITY BELLEVUE ST, WA ZIP 980046719
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: ❑ 38
INTERLOCKYES NO INTERLOCK YES DNO YES NO
19 DRIVER'S STATE WA SEX M D.O.B. 12 25 1980 39
LICENSE# MMDOYY —
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE I PLATE# BFS3801 raTE WA vIN# WPOAA2A79HL102187 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2017 MAKE pORS MODEL pANAME STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO MARCUS TRUFANT 209 NORTHSIDE RD BELLEVUE WA 980046719 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO TBD,
IN EFFECT &POLICY# 9TOP
HICL
L'—L YES❑ NJ—I, CITATION11 CHARGE tO BOTTOM
VEE
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF68534
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1404
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 NJURY NATURE OF INJURIES
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
gm/1 lane 2 slid out hit wall cut off unit 2/blk
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at about the 2500
block of Maple Valley Hwy.
I contacted the driver of unit 2 who told me he was eastbound on MVH in lane one when unit 1 slid
out of control and contacted the front of his vehicle. He did not complain of injury and damages did
not require a tow truck.
I contacted the driver of unit 1 who told me he was in lane 2 of of the eastbound lanes of MVH when
he must of hit some black ice in the left curve. This caused his vehicle to slide across lane 1,
contacted the front of unit 2. He contacted the jersey barrier and came to rest in lane 1. He did not
complain of injury and 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 2/13/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-14-25 07:58 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 212412025 12:23:35 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 8:21 AM TIME POLICE ARRIVED i 8:23 AM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EF68534 CASE# 25-1404 DATE AND TIME 02/13/2508:17
OF COLLISION
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