HomeMy WebLinkAbout25-5295 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG06260oc� RA
COLLISION REPORT 1591971
CASE# 25-5295 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENC'Y 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
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
coulsloN' 06 - 17 - 2025 1717 17 =.�� S W e IN
OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
SUNSET BLVD N BLOCK NO. e 300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 400 00 FEET e✓ S 8 E e N 3RD ST
2 0 29
F
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2063558778 0 1 30
5 LAST NAME DAVIS-FRAME FIRST NAME MARIAH MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 1313 W JAMES ST APT 1 CITY KENT ST WA ZIP 980324372 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKYEs Na YES No
8 DCIEVERS NS STATE WA SEX F 09 MMorYY' 04 - - 2002 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
10 as ENS1tEI BZE9225 STATE WA VN# JNIAZOCP2BT001366 3
11[-j- TRAILER STATE TRAILER ..STATE ROM TO
11 3 0 PLATE# PLATE#
rRLR TRLR 1 5 33
12 3 Q VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 2 2011 N/SS LEAF DAMAGE YES�No ✓� Yes 1 5 34
REGISTERED OWNER INFO MARIAH DAVIS-FRAME 1313 WJAMES STAPT I KENT WA 980324372 D:2063558778 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO
14 PROGRESSIVE 949096726
IN EFFECT &POLICY# 9TOP
vE` CHARGE t S 36
""ALLY
yes❑NO❑ CITATION# 7 o BOTTOM
15❑ STM ING s 7 e
III MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT O2 VEHICLE CYCLE nWNFR YES,/ NO D:3607129269
16�
LAST NAME WINKLE FIRST NAME MARSHALL MIDDLEI D
INITIAL
17 F1 STREET ❑❑ 37 303 S l ST CITY ABERDEEN ST, WA ZIP 985206615
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED fGNIT10N PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYEs No INTERLOCK YES No ves NO
19 DRIVER'S STATE WA SEA,M DOs. 05 13 1988 ❑ 39
LICENSE# MD-OB-
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E D30994A rarE WA vIN# 3TMCZ5AN6JM145777 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q1$ MAKE TOYT MODEL TACOMA STYLE VEHICLETOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO MARSHALL WINKLE 303 S 1,11 ABERDEEN WA 985206615 D:3607129269 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO GEIC04624393874
IN EFFECT &POLICY# t 9TOP
HICL
LEIAIL YES❑ N CL J CITATION# CHARGE tO BOTTOM
VEE 6
__J
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG06260
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5295
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS El 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
blu/2 lane 2 slv/1/In 3 merge inti 2 both expired
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash at about the 350 block of
Sunset Blvd N.
I contacted the driver of unit 2 who told me that unit 1 changed lanes into the side of his vehicle. He
was southbound in lane 2/Sunset Blvd N. He did not complain of injury and damages did not require
a tow truck.
I contacted the driver of unit 1 who told me she was changing lanes from lane 3 into lane 2 and as
she was almost done with her lane change she and unit 2 contacted. She did not complain of injury
and damages did not require a tow truck.
There were no witnesses to corroborate either drivers story and this was a he said she said with no
other observable evidence.
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 6/20/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 06-20-25 11:32 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 71312025 8:38:40 AM
BADGE OR ID# 2517 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:17 Pry TIME POLICE ARRIVED 5:24 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG06260 CASE# 25-5295 DATE AND TIME 06/17/25 17:17
OF COLLISION
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