HomeMy WebLinkAbout23-1944 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-1944 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 02 - 1-- 2023 1342 17 ❑.= S 8 E IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ Y800
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ E e NE 10TH ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4256260822 0 11
30
6� LAST NAME ROBITOY FIRSTNAME RYDER MIDDLE J 1 1 2 31
INITIAL
STREET ❑1 17255 135TH AVE NE#G316 CITY WOODINVILLE ST WA 2jp, 98072 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9� P1 AT 14 615XFZ STATE WA VIN# JTLKE50E781026656
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 5 3 33
12 3 5 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 3 34
13 2 2008 TOYT SCION DAMAGE YES NO �MEYER YES : NO✓
REGISTERED OWNER INFO ASHLYADAMS 2.1 E LAKE SAMMAMISH PKWY NE SAMMAMISH WA 98074 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# 9TOP
❑ LEGALLY LE CHARGE 5 36
15 2 res No clTAnoN# 3A0081040 FAIL YIELD PRIVATE RD MOTOR o aorrob
1.' MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES NO D:9716789159
16 a
LAST NAME CHRISTENSEN FIRST NAME MICHAEL MIDDLE C
INITIAL
17❑ STREET ❑' 30038 S WALL ST CITY''' COLTON ST' OR ZIP 97017 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t- l No❑
19 DRIVERS#
ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES 40
USE CLASS NECK
21❑ LICENSE I BZH5240 TATE WA VIN# JM1BK12G261474909
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2006 MAKE MAZp MODEL 3 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES✓ NO GENE MEYER YES NO
REGISTERED OWNER INFO MICHAEL CHRISTENSEN 852433RD AVE S LAKEWOOD WA 98499 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
'E""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY 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. ED35845
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1944
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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'
blk suv rt from pl blu sedn lane 1 eb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at 2800 block of NE
Sunset Blvd.
I contacted the driver of unit 2 who told me he was eastbound lane 1 on NE Sunset Blvd when unit 1
pulled out in front of him without time to avoid contact. He did complain of sore neck but refused
Renton Fire. His vehicle was towed for damages.
I contacted the driver of unit 1 who told me he forgot his wallet, but showed by his ASB card. A
WACIC/DOL check revealed a matching DOL photo Wadl. Unit 1 told me he was pulling out of the
parking lot but not without yielding to unit 2. He did not complain of injury and damages did require a
tow truck.
I cited Unit 1 ref RCW 46.61.205 FTYROW from Private Drive 2 car injury crash via complaint.
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 2/17/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 02-17-23 02:32 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 2/21/2023 10:30:21 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 1:42 Pry TIME POLICE ARRIVED',1:48 PM
PART I PAGE IT]OF
REPORT NO. ED35845 CASE# ' 23-1944 DATE AND TIME 02/17/23 13:42
OF COLLISION
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