HomeMy WebLinkAbout25-1769 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EF71562 170
27
COLLISION REP FIT 1591971
SASE 25-1769 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 02 - 1-- 2025 0752 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 3800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET e S ❑ W e QUEEN AVE NE
0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2068160901 0 11
30
6� LAST NAME LAM FIRSTNAME SANG MIDDLE A 1 2 31
INITIAL
STREET ❑ 9700 RENTON AVE S CITY SEATTLE ST WA ZIP, 981185722 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO I INTERLOCK YESO NO M YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E CLASS 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� CMR0525 sTATI WAvIN# JTDL9RFU6L3021312
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR 1 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN I
TOWED BY GOVT.VEHCLE 3 ] 34
13 2 2020 TOYT PRIUS DAMAGE YES f n O YES[:] H
REGISTERED OWNER INFOSANG LAM 11.RENTON AVE S SEATTLE WA 98118 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAFECO H2347954 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE 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 1/ NO D:5056815069
16 a
LAST NAME MCGARVEY FIRST NAME ISAAC MIDDLE A
INITIAL
17❑ STREET ❑', 11301 NE 128TH ST APT A202 CITY KIRKLAND ST WA ZIP 980344740 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 LDIIVEW # STATE WA SEX M M .C.B. 08 _ 24 1985 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BQW5121 TATe WA vIN1 4T1B846KX7U019883
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2007 MAKE TOYT MODEL CAMRY STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ISAAC MCGARVEY 11301 NE 128TH ST APT A202 KIRKLAND WA 980344740 D:5056815069 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04429-63-14-03IN IU
9TOP
'E""LE ❑ ,J� CITATION# CHARGE o BOTTOMLEGALYYES N`L J25 '
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. EF71562
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1769
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
POS. 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'
gry/1 rt rom driveway sil 2 lane 1
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash near the 3800 block of NE
4th St.
I contacted the driver of unit 2 who told me he was westbound lane 1 NE 4th St, when unit one made
a right turn from an apartment complex driveway without enough time to avoid contact. 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 made a right turn and then was rear-ended by unit 2.
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 2/25/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-25-25 04:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 3/6/2025 2:12:58 PM
BADGE OR ID# Y517 ORI#' ' WA0171300 TIME POLICE DISPATCHED 7i82 AM TIME POLICE ARRIVED 8:00 AM
PART I PAGE IT]OF
REPORT NO. EF71562 CASE# 25-1769 DATE AND TIME 02/25/25 07:52
OF COLLISION
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