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HomeMy WebLinkAbout25-2513 IT �i " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF75515 STATE OF COLLISION REPORT 1591971 CASE# 25-2513 2 INTERSTATE CITY STREET El STATE ROUTE OTHER LOCALANG 4250 3 C©DINGCOUNTY RD PRIVATE WAY 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# EDGE s o v' 03 - 20 - 2025 0805 17 =.= S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. SW SUNSET BLVD 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET e S 8 W e STEVENS AVE SW 0 1 29 MOTOR PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO Q 6 30 6 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31 INITIAL STREET ❑) CITY', ST ZIP 2 NEW ADDRESS 7� +COL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO INTERLOCKVEs NO YES NO 8❑ LCEENSE# SRVERISTTATE SEX U MMDDYY' —=— 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 HELM USEET 9 CLASSY 0 NATURE OF INJURIES 2 LICENSE, 3 10� PI ATP# STATE V(N TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR TRLR 3 7 33 12 3 5 VIN# VIN# FROM TO VEH.YEAR MAKE MODEL STYLE V 3 7EHICLE TOWED TO BUN TOWEBBv GOVT VEHICLE 34 13� DAMAGE YES�NO� YES❑ NO REGISTERED OWNER INFO (NEW] VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP vEnicLE CHARGE 5 36 LE,,ALLY YES❑NO❑ CITATION# t a BOTTOM 15❑ sTnNowc 7 e 11 UNIT 02 MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE VEHICLE CYCLE nWNRR YES'I NO 16� LAST NAME GOMMI FIRST NAME JULIE MIDDLE L INITIAL 17 F1 STREET ❑❑ 5832 S 238TH CT APT C5 CITY KENT ST, yyq ZIP 980323705 g 37 NEW ADDRESS 1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38 CDL INTERLOCKYEs NO INTERLOCK YESEl No YES NO 19 DRIVER'$ ' STATE WA SEX F I D.O.B. 10 30 1972 � 39 LICENSE# MMDDYY - HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSE 676ZBP raTE WA vIN# 5J6RE48519LO23373 41 22❑ [TILER TAILER PLATE# STATE PLATE# STATE E 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR ZQQ<J MAKE HOND MODEL CR-V STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24� DAMAGE YES NO� VES NO REGISTERED OWNER INFO JULIE GOMMI 5832 S 238THCTAPTC5 KENT WA 980323705 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO USAA 00783 09 99C IN EFFECT &POLICY# I STOP VEHICLE ❑ CITATION# CHARGE to BOTTOM LEGALLY YES N 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 M.LEVERTON 2517 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF75515 COLLISION REPORT III III III III III 111 1591972 CASE# 25-2513 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 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 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 gry/2 slwoing lane 2 raer blk 4 dr RTF Within the city limits of Renton/King/WA I responded to a blocking hit and run at the intersection of SW Sunset Blvd at Stevens Ave SW. I located unit 2 who had moved her vehicle to the shoulder prior to my arrival. She told me an unknown suspect/black 4 door square car hit her in lane 2 westbound while she was slowing for the yellow light. She said she was hit was enough force that unit 1 can to back up to detached the two cars. After which that car/unit 1, fled without remaining and providing any information. Unit 2 did not get a license plate or description of driver. Unit 2 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 3/20/2025 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 03-20-25 01:19 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY ATE M.LEVERTON 2517 3/20/2025 1:55:24 PM D BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 8:05 AM TIME POLICE ARRIVED i 8:12 AM DART B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3 REPORT NO. EF75515 CASE# 25-2513 DATE AND TIME 03/20/2508:05 OF COLLISION .:. iT VON, 3 � a�, gg ae } 4 Y L� is YttSY i gj#,4izhz tf} 34y ►4 i� r { L m sL, — Y } ; i i L� s ti � TiJ z} i } to t t' �1 �t sfi 1 } t} 3 t , , 9 d" x PAGE 3 OF 3