HomeMy WebLinkAbout23-2088 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-2088 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4950 3
HIT&RUN ✓ CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 5 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# ❑
cowsloN 02 - 1-- 2023 1138 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 440
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 350 00 FEET MILES e S B W e S qTH PL
0 1 29
UNIT
MMO tOR� Z PEDAL- ElDAMAGE THRESHOLD MET PHONE
01 CYCLE YES NO 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE# STATE SEX u MMDOOYY - 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
C7
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
rRLR. TRLR. 5 1 33
12❑ VIN# VIN# fn
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 3 DAMAGE YES NO ✓ YES❑ NO✓
REGISTERED OWNER INFO [NEW] VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
UNIT 02 VE IOOR ❑ CYCLE ❑ PEDESTRIAN ❑✓ OWNER
❑ DYES✓ NO�TFIRrI.LDMET PHONE
16 a
LAST NAME MARSHALL FIRST NAME CODY MIDDLE S
INITIAL
17 STREET❑ NEW ADOREss❑' 1320 MARINE VIEW DR CITY' PORT ANGELES ST' WA ZIP 98363 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I No� YES t l NO❑
19 F] LDI IVE # STATE SEX M MMDDYY 11 20 _ 1995 El 39
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT HELMET INJURY 7 NATURE of INJURIES 40
USE CLASS L LEG
❑21❑ LICENSE TATE 41
VIN# `1
PLATE#
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 O 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO 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. ED38436
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2088
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VEN/SHNlCK REBBECCA H
(LAST FIRST,
ADDRESS&PHONE# D O.B.
613 S 31 ST RENTON WA 98055 2066172523 SEX F MMDDYyYv 12 - 29 - 1956
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET NJURY NATURE OF INJURIES
❑✓ ; POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Id I DOB
E MMDDYYYY
PASSENGER []WITNESSO UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 02-21-23 01:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 31112023 7:16:59 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 11:39 AM TIME POLICE ARRIVED',11:39 AM
PART I PAGE IT]OF 4�
TIME
REPORT NO. ED38436 CASE# 23-2088 OF COLLISIONO2/21/23 11:38
NARRATIVE
RTF
Within the city limits of Renton/King/WA I responded to a car v ped crash hit and run near the 440
block of Rainier Ave S.
When I arrived a found a male laying mostly face down and not responsive to questions in the
driveway apron of a local store.
Fire was arriving about this time.
I contacted one witness that said she was behind a green truck maybe 50' or greater when a
pedestrian walked into the roadway from east to west when he was hit by that green truck. The green
truck fled and left the ped in the roadway. An unknow person stopped and drug the ped to the east
driveway apron.
The ped was breathing and did not have any obvious serious injury. Both his shoes were still on his
feet, so low speed impact. When Medics arrived and after a quick check they passed the
Ped/Marshall back to Renton Fire for transport/minor injury. Marshall was transported to VMC-ER.
I contacted Marshall there and he refused to answer any questions.
No suspect information other than a s-10 type truck. Victim no will to provide any additional
information.
Information 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 2/21/2023
PAGE 3 OF 4
REPORT NO. ED38436 CASE# ' 23-2088 DATE AND TIME 02/21/23 11:38
OF COLLISION
n s
PAGE 4 OF 4