HomeMy WebLinkAbout25-9211 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 25-9211 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
23❑ 6 0
TOTAL#OF OBJECT 1 28
TRIBAL UNITS 02 STRUCK' TRAFFIC SIGNAL POLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 10 - 1-- 2025 1258 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
PARK AVE N MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 3RD ST
0 1 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓NOESHOLDMET PHONE 0 11
30
6� LAST NAME HAMPTON FIRSTNAME BEVERLY MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 4800 S JUNEAU ST CITY SEATTLE ST WA ZIP, 981182848 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H U SE INJURY -, [NATURE
CLASS 7 I CHEST OF INJURIES 2❑
3
10❑ P1 aT�S� CKR8484 sTArI WAurN# WA16NAFY4L2016007
5
----� TRAILER STATE PLAT Eft STATE
11 2 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34
13 1 2020 AUDI Q5 DAMAGE vesNo � �MEYER ves❑ No✓
REGISTEREDOWNERINFO BEVE I.MPTON4800SJUNEAUST SEATTLE WA98118 D:2063138806 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE NSURANCE CO SAME. 4
IN EFFECT &POLICY#VE—LE CHARGE36
LEGALLv Yes❑NO CITATION# <,IQ
15❑ STAIN.D'ING 6
UNIT VEHIMOTCLE CYCLE ❑ PEDESTRIAN ❑ OWNER PEDAL YES
❑ DYES✓ NO OLDMET PHONE
16 a
LAST NAME HARTMAN FIRST NAME RONALD MIDDLE I D
INITIAL
17❑ STREET ❑', 37456 SE FISH HATCHERY RD CITY FALL CITY ST WA ZIP 980249778 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALT�RANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YES I t I.OF YES t t— l NO❑
19[—] DRIVER'S STATE WA SEX M D.Q.B. 11 07 1970 39
LICENSE# MMDDYY
HELMET I INJURY 6 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS BROKEN R 4TH FINGER ❑
21❑ LICENSE I C59474W TAre WA VIN1 1GT49VEYMF227394
❑ 41
PLATE#
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2021 MAKE GMC MODEL SIERRA STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO✓
REGISTERED OWNER INFO RONALD HARTMAN 37456 SE FISH HATCHERY RD FALL CITY WA 98024 D:2274924478 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
VE""LE ❑ Nu,J CITATION# CHARGE io BOTTOM
LEGALLY YES
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG44826
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9211
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
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 10-24-25 03:28 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 111412025 10:26:19 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED'; 12:58 PM TIME POLICE ARRIVED',4:00 PM
PART I PAGE IT]OF 4�
REPORT NO. EG44826 CASE# 25-9211 OF COLLISION
10/24/25 12:58
OF CbLLI510N
NARRATIVE
blk/suv/1 eb blu/trk/2 nb
RTF
Within the city limits of Renton/King/Wa I responded to an unknown if injury blocking crash at the
intersection of Park Ave N at N 3rd St.
There had been power outages in the area for hours and this area was affected by that. This
intersection is controlled with electrionic traffic control devices. The intersection was blacked out with
no power controlling the signals. Ref RCW 46.61.183 The driver approaching an intersection with
temporary power outages, shall consider the intersection to be ab all-way stop. This intersection was
not being controlled by police, fire or another authorized flagging worker.
I contacted the driver of unit 1 who told me she was eastbound on N 3rd St and was hit by unit 2 in
the intersection. She complained of injury and was treated on scene by Renton Fire. She was
transported to VMC-ED by Tri-Med for further checks. Her vehicle was impounded for heavy
damages by Gene Meyer.
I contacted the driver of unit 2 who told me he was northbound lane 2 and said he did not see a red
light. He told unit 1 came out of nowhere and they collided. He did complain of injury. He was
treated on scene by Renton Fire and later transported by Tri-Med to VMC-ED for additional treatment.
His vehicle was impounded for heavy damages by Gene Meyer.
Post collision unit 2 had a secondary impact with a city of Renton street light pole up on the sidewalk-
NE corner. The city was notified and checked the pole for damages, minor contact.
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 10-24-2025
PAGE 3 OF 4
REPORT NO. EG44826 CASE# ' 25-9211 DATE AND TIME 10/24/25 12:58
OF COLLISION
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