HomeMy WebLinkAbout25-1204 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF68538OLCERA
COLLISION REPORT 1591971
CASE# 25-1204 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 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' 02 - 06 - 2025 1345 17 =.= S 8 W e OF e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
PARKAVEN BLOCK NO. e 300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e N 3RD ST
0 2 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 0 6 30
6 LAST NAME KLONOFF FIRST NAME KENLEY MIDDLE R 1 1 2 31
INITIAL
STREET ] 11202 SE 186TH ST CITY; RENTON ST WA ZIP; 980557107 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEflIGAL TRANSPORTED 3
INTERLOCK YES No INTERLOCKVEs NO YEs No
8 DRIVER # STATE WA SEXI M MMDDYY' 07 — 13 — 1975 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 1HELM
USEET CLASSY 1 NAruRE of INJURIES 2
LICENSE, CCT0315 STATE WA VIN# 3VW267AJ8GM323272 3
10[9� as ATP rt
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# ROM To
TRLR TRLR 5 1 33
12 3 5 VIN# vIN#
FROM TO
13 2 VEH.YEAR 2016 MAKE VOLK MODEL ✓ETTA STYLE VEHICLE TO YED NO fj'4 N TgAWIZLRS YES❑E ND 5 1 34
DAMAGE IIII._IIII HHttVVii((tt
REGISTERED OWNER INFO KENLEY KLONOFF 3376224TH PL SW BRIER WA 98036 D:4255999841 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 14 LIABILITY INSURANCE� INSURANCE CO PROGRESSIVE 909 526 365 4
IN EFFECT &POLICY# 4TOP _
YEs
""ALLY
�NO❑ CITATION# 5A0151270 CHARGE IMPROPER LANE USAGE s t a ooTro�m z 36
15 STM
MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2065794997
16�
LAST NAME ✓ARSO FIRST NAME FEYSAL MIDDLE' N
INITIAL
17
STREET ❑ 37
NEW ADORE SS❑ 6413 29TH AVE SW CITY SEATTLE ST, WA ZIP 981262999
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCKYES NO INTERLOCK YES No YES No
19 DRIVER'S STATE I WA SEX M D.0.8. 02 05 1997 � 39
LICENSE# MMDDYY —
:
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY NATURE OF INJURIES 40 USE CLASS 1 ❑
21 LICENSE CNP9705 TATe WA VIN# 4T4BF3EK6BR161971 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2011 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO FEYSAL JARSO 641329TH AVE SW SEATTLE WA 981262999 D:2065794997 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO GENERAL 53-WA$001943
IN EFFECT &POLICY# t STOP
Ve—L ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES N`[
25 s
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. EF68538
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1204
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 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
PC& I 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 02-07-25 08:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 212412025 12:14:35 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 1:45 Pry] TIME POLICE ARRIVED i 1:47 Pry
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF68538 CASE# 25-1204 OF DATE AND r�N + 02/06/25 13:45
O�COLLISION
NARRATIVE
GRAY/2 SLOWING 4 WAYS GRAY1/CHANGING SUN
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash near the 300 block
of Park Ave N.
I contacted the driver of unit 2 who told me he was northbound Park Ave N lane 1, slowing down to
locate an address and had his 4-way hazard lights flashing. He told me he was hit from behind by
unit 1, which forced him up and over the sidewalk. He did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was northbound Park Ave N
lane 1 and saw unit 2 with his hazard's flashing. He told me he was preparing to make a lane change
but did not do it in the intersection because he believed it was illegal. He told me when he cleared
the intersection he did a head check and was blinded by bright sun light and at the same time was
making his lane change but not enough to have struck with his driver side headlight area of his
vehicle and driver side taillight area of unit 2. He did not complain of injury and damages required a
tow truck.
I cited unit 1 via complaint ref RCW 46.61.140 Improper lane use 2 vehicle collision.
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 2/7/2025
PAGE 3 OF 4
REPORT NO. EF68538 CASE# 25-1204 DATE AND TIME 02/06/2513:45
OF COLLISION
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PAGE 4 OF 4