HomeMy WebLinkAbout25-3102 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF81513oc� RA
COLLISION REPORT 1591971
CASE# 25-3102 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`GENC'Y. 4100 3
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coLLISION' 04 - 06 - 2025 1836 17 =.= S 8 W E IN OF M ?070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
TALBOTT RD S BLOCK NO. e 1500 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e S PUGET DR
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO Q $ 30
6 LAST NAME VERIGA FIRST NAME PETRUTA MIDDLE 1 1 2 31
INITIAL
STREET ❑ 24116 62ND WAYS,APT 16-101 CITY KENT ST WA ZIP 98032 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ND INTERLOCKYEs NO YEs No
DRIVER # STATE WA SEX F MM0,8. 07 - 14 - 1980 t 1 2 32
8❑
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 H USEET 2 I INJURY
CLASS ? NAruRE of INJURIES 2
LICENSE, C65614K STATE WA VN# 5TEGN92N32ZO29377 3
10 Fl I PI ATF#
TRAILER STATE TRAILER ,STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR TRLR 5 1 33
12 0 0 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 9 9 34
13 2 2002 TOYT TA COM PK DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO CRISTINE BLANKENSHIP 1103194TH STNE LAKE STEVENS WA 98258 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 3 4
14 AAA CAAS554489903
IN EFFECT &POLICY# 4TOP
vEnic�E 5 36
LEGALLY YES❑NO❑I CITATION# CHARGE 7 o BOTTOM
15❑ STANDING I 7 e
III MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR YES,/ NO D:7028607583
16�
LAST NAME HARDY FIRST NAME CLOURSE MIDDLEI q
INITIAL
17 F1 ?
STREET ❑
'❑ 7917116TH AVE SE CITY I RENTON ST, WA ZIP 98058 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPORTED: 38
INTERLOCKYES CKYES NO Yes No'
19 DRIVER'S STATE WA SEX M D D B 12 _ 05 1985 39
LICENSE# MMOYY
20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE A INJURIES 40
USE CLASS BACK PAIN
21 LICENSLATE E CFC4867 rarE WA vIN# WAUENAF42HN019863 41
22❑ PLTL ATE# STATE TILER PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2017 MAKE gUDI MODEL q4 STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO,2
SHADE IN DAMAGAREA
2 3
LIABILITY INSURANCE INSURANCE CO GIECO 6118645990
IN EFFECT &POLICY# I 9TOP
VEHICLE LEGAIL,v ,.ILJ
—I CITATION# CHARGE tO BOTTOM
25 YES N` s 7 e
---J
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF81513
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3102
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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.
KEITH PETTY 04-06-25 08:56 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
NOAH GIRELLO 12607 4/10/2025 9:30:21 PM
BADGE OR ID# 12809 ORI# WA0171300 TIME POLICE DISPATCHED'; 7:42 Pry! TIME POLICE ARRIVED 7:47 PM
PART B 3oDo-345-,ao(Rtlras) PAGE 27 OF 47
REPORT NO.` EF81513 CASE# 25-3102 O COLLI COLLISION TIME
OF 04/06/25 19:36
COLLI
NARRATIVE
25-3102
On 04/06/2025 at approximately 1942 hours, I was dispatched to the intersection of S Puget Dr and
Talbott Rd S in the City of Renton, King County, Washington, for motor vehicle collision with possible
injuries.
I contacted the unit 2 driver, Clourse Anthony Hardy (DOB 12/05/1985) identified by his WADL. Hardy
was driving his black 2017 Audi A4 (CFC4867/WA) VIN/WAUENAF42HN019863.
Unit 1 driver Petruta Veriga (DOB 07/14/1980), had told Hardy that her baby was hungry, and she
needed to go. She took pictures of the vehicles and then had sent a picture of her WADL and
insurance to Hardy through a Gmail number. The insurance was listed for the Beige 2002 Toyota
Tacoma (C65614K/WA) VIN/5TEGN92N32Z029377 that was involved in the collision.
Hardy stated that he was heading north on Talbott Rd S and stopped at the red light at the
intersection of Talbott Rd S and S Puget Dr. The driver of unit 1 did not stop in time and collided into
the back of his vehicle causing damage to the rear passenger side.
Hardy had stated that he was feeling pain in his back and had RRFA check and clear him at the
scene. Hardy was going to seek further medical later.
I provided Hardy with a business card and case number.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 04/06/2025t 2046 hours, Place: Renton, King County,
Washington.
PAGE 3 OF 4
REPORT NO. EF81513 CASE# 25-3102 DATE AND TIME i 04/06/25 19:36
OF COLLISION
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