HomeMy WebLinkAbout25-4914 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-4914 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. Os - 1-- 2025 1015 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
GARDEN AVE N BLOCK NO. e✓ 677
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET MILES e S B W e N 8TH ST
0 1 29
MOTU '�01 VEHtOR PI CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 0 3 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY FEDERAL WAY ST ZIP' 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10 9� Pi LICETNS
14 BUB4322 STATE WA VIN# 1 VWBH7A33CC097603
TRAILER STATE TRAILED STATE
11 2 5 PLATE# PLATE# FR.. ro
TRLR. A'RLR. 1 5 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 7 34
13 2 2012 VOLK PASSAT DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO RA'DIYA RODRIGUEZ 16411 MAY CREEKRD GOLD BAR WA 98251 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE 5 36
LEGALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069995886
16 a
LAST NAME IGAWA FIRST NAME ALLEN MIDDLE D
INITIAL
17❑ STREET NEW ADOREss❑' PO BOX 121 CITY FEDERAL WAY ST' WA ZIP 98093 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALt-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NoF YES t l NO❑
19 LDIIVEW # STATE WA SEX U MMDDYY 11 11 1961 El 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
❑21❑ PLATE# C83333U TATe 41
WA VIN1 3TMDZ58N6LM091600 4
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2020 MAKE TOYT MODEL TACOMA STYLE VEHICLE TOWED TO BLIN TOWEDeY GOS HI 44
L4❑ DAMAGE YES NO� YES NO
REGISTERED OWNER INFO ALLEN IGAWA PO BOX 121 FEDERAL WAY WA 98093 D:2069995886 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
M.LEVERTON 2517 0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG60672
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4914
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'
wht/2 rt to boeing pl rear slv/1 hit drops daughter off and comes back argues and leaves without ID
Within the city limits of Renton/King/Wa I was dispatched to a hit and run by phone. I contacted the
victim/unit 2 by phone.
Unit 2 told me that he was south on Garden and was making a right turn into a Boeing parking lot. He
told me was about 3/4 over the sidewalk when he was hit in the back right side of his vehicle by unit
1. He told me that he and unit 1 stopepd and made contact but unit 1 did not provide his information.
He told me unit 1 said he was late dropping of his daughter at a local elementary school. He said unit
1 told unit 2 he would be right back after he drops off his daughter. Unit 2 told me that unit 1 did
come back to the location. But rather than providing his information he remained in his vehicle and
was somewhat verbally hostile. Unit 2 recorded his on his cellphone and provided me the opprotunity
to view the vehicle and driver.
The license plate ref unit 1 returned to a vehicle involved in a crash in the city prior, Washington
license number BUB4322. This vehicle comes back to a female RO. A local records check comes
back to a Davis, Jeffery S 10-01-1991. There was no DOL record found in Washington but he has a
DOL record out of New Jersey. New Jersey provided a DOL photo of Davis that matched the video of
the driver provided by unit 2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 06-24-25 10:45 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 12/19/2025 12:31:59 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED' 10:18 AM TIME POLICE ARRIVED 10:22 AM
PART I PAGE IT]OF 3�
REPORT NO. EG60672 CASE# ' 25-4914 DATE AND TIME 06/06/25 10:15
OF COLLISION
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