HomeMy WebLinkAbout25-2013 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF71843OLCERA
COLLISION REPORT 1591971
CASE# 25-2013 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 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' 03 - 04 - 2025 0917 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
SE 128TH ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e 162ND AVE SE
0 1 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2533498868 0 7 30
6 LAST NAME CARLSON FIRST NAME CHRISTOPHER MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 27246121STAVESE CITY; KENT ST WA ZIP; 980308819 2
NEW ADDRESS
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs NO INTERLOCKVEs No YES NO
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 07 — 10 — 1998 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 1
NATURE of INJURIES 2
10 al ENSttEI BCJ4942 STATE WA VIN# JTDZN3EUXHJ060217 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR rRLR 7 1 3 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2017 MAKE TDy. MODEL pRIUSV STYLE VEHICLE TOWED TO BLIN TOWED By GES VEHICLE 9 9 34
13 DAMAGE YES YES NO
REGISTERED OWNER INFO GRANITE AND MARBLE SPECIALTIE 1864068TH AVE S KENT WA 98032 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3
14 LIABILITY INSURANCE[%,/] INSURANCE CO SAME. 4
IN EFFECT &POLICY# 9TOP
V""' CHARGE 5 36
15
srnNowc YES❑NO❑ CITATION# INATTENTIVE DRIVING t a oorrob
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2069302271
16�
LAST NAME HARRIS FIRST NAME SHARA MIDDLE' L
INITIAL
17 STREET ❑ 17002 196TH AVE SE CITY RENTON ST, WA ZIP 37
980580718
NEW ADDRESS I I I I 1
❑
18❑ IGNITION REQUIRED IGNITION PRESENT MEDfCALTRANSPORTED 38
CDL INTERLOCKYEs No INTERLOCK YES xz YEs NO
19 DRIVER'S ' STATE WA SEXI F I D.O.B. 06 11 1975 � 39
LICENSE# MMDDYY I -
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21[ LICENSE CEU5297 rarE WA VIN KMUHCESC1PU143604 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
43
23 VfN RLR
UIN#. 'IN#
VEH.YEAR 2020 MAKE UNKN MODEL DUNE STYLE VEHICLE 44
TOWED TO BLIN
TOWED BY GOV HI
24� DAMAGE YES NO� VES NO
REGISTERED OWNER INFO TODD HARRIS 17002196TH AVE SE RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGEAREA
2 3
LIABILITY INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# t STOP
VEHICLE ,.I—I CITATION11 CHARGE to BOTTOM
L'—LY YES[Z N
25
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. EF71843
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2013
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 03-05-25 07:33 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY E
DAT
M.LEVERTON 2517 31712025 2:29:22 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 9:18 Aryl TIME POLICE ARRIVED i 9:37 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF71843 CASE# 25-2013 OF DATE AND r�N + 03/04/25 09:17
O�COLLISION
NARRATIVE
wht/1 rear stopped wht/2 suv hygennisis gv80
CC
Within the city limits of Renton/King/Wa I responded to a two vehicle crash at the SE 128th St at
162nd Ave SE
I contacted the driver of unit 2 who told me she was stopped eastbound SE 128th Ave NE in the left
turn lane when she hit from behind by unit 1. She did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 1 Id'd by picture WADL. He was also pulling into the left turn lane but did
not notice unit 2 was stopped and crashed into the back of her. He did not complain of injury and
damages did not require a tow truck.
I cited unit 1 ref RMC Inattentive Driving 2 vehicle crash via complaint.
Unit 2 vehicle is listed as a unknown dune buggy as her Genises gv80 is not a sector option.
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 3/4/2025
PAGE 3 OF 4
REPORT NO. EF71843 CASE# 25-2013 DATE AND TIME 03/04/2509:17
OF COLLISION
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