HomeMy WebLinkAbout25-2531 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF75491OLCERA
COLLISION REPORT 1591971
CASE# 25-2531 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 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 - 20 - 2025 1216 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
S 2ND ST MILE POST
❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ C------ 1.1 FEET e S 8 W e LOGAN AVE S
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4254661596 30
6 LAST NAME CHABOT FIRST NAME GAIL MIDDLE S 1 1 2 31
INITIAL
STREET ❑ 12523 SE 67TH ST CITY; BELLEVUE ST WA ZIP; 980063991 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCK YEs No YES NO
8 DRIVERS# STATE WA SEXI F MMDDYY' 07 — 03 — 1944 t 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 NATURE of INJURIES 2
10 LI ENSE' ATZ2677 STATE WA VIN# 1FADP3R47FL232712 3
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR TRLR 3 1 5 33
12 VIN#' VIN#
FROM TO
VEH.YEAR 2015 MAKE FORD MODEL FOCUS STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 3 34
13� DAMAGE YES II_II NO `/ YESII_] NO
REGISTERED OWNER INFO GAIL CHABOT 12523 SE 67TH ST BELLEVUE WA 980063991 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 STATE FARM 5119373 D06 47
IN EFFECT &POLICY# 4TOP
VEn" CHARGE t 5 36
Lec , YES❑NO❑ CITATION# 70 60TTOM
15❑ STM ING e
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT�' PEDESTRIAN Q✓ D:2066095751
VEHICLE CYCLE OWNER
YES NO
16�
LAST NAME RYAN FIRST NAME HEATHER MIDDLE E
INITIAL
STREET ❑
17 ❑ 22250 83RD AVE S CITY KENT ST, WA ZIP 98032 37
NEW ADORE SS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38
INTERLOCKYES NO INTERLOCK YEs NO YES NO
19 DRIVE # STATE SEX F MMOB7 02 14 1981 39
ON DUTY STATUS 6 AIRBAG RESTR EJECT R U ET INJ ICY 1 NATURE OF INJURIES ❑ 40
21 1
LICENSE I PLATE# TATE VIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 0 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
1-1— ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES NCO
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.Li
2517 WA0171300
PART A PAGE 01 OF
3000-348-189(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF75491
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2531
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 03-20-25 01:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY E
DAT
M.LEVERTON 2517 312012025 1:23:40 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 12:15 PM TIME POLICE ARRIVED i 12:18 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF75491 CASE# 25-2531 OF DATE AND r�N + 03/20/25 12:16
O�COLLISION
NARRATIVE
wht/1 It s 2nd we w-e s side
RTF
Within the city limits of Renton/King/Wa I responded to the intersection of S 2nd St at Logan Ave S for
a car v ped crash.
When I arrived the Ped/wheelchair was being looked by Renton Fire only as a precautionary check,
as she did not complain of injury.
Another officer on scene told me the following:
Unit 1 was westbound lane 4 and preparing to make a left turn onto Logan Ave N on her green light.
She did not see the Ped in the crosswalk and contacting her wheelchair. It caused some minor
damage to her vehicle which did not require a tow truck and unit 1 did not complain of injury.
Ped was in her wheelchair crossing in the marked crosswalk from the west to the east on the south
side of the intersection, when she was contacted by unit 1. She did not complain of injury, in fact she
said she was getting used to this as this was number 4 times she had been hit by a car while in her
wheelchair. Unremarkable damage if any to the wheelchair.
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 3/20/2025
PAGE 3 OF 4
REPORT NO. EF75491 CASE# 25-2531 DATE AND TIME 03/20/2512:16
OF COLLISION
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