HomeMy WebLinkAbout23-2250 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED40385 170
27
COLLISION REP FIT 1591971
CASE 23-2250 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 02 - 1-- 2023 1405 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
N 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ 1.❑ FEET e S ❑ W e PARKAVEN
2 0 29
UNIT MOTOR
VEHICL PI CYCLE
ElDDAMYESA✓THRESHOLD MET PHONE 0 1 30
6� LAST NAME CORTEZ FIRSTNAME FRANKIE MIDDLE G 1 1 2 31
INITIAL
STREET ❑ 19835 121 ST AVE SE CITY KENT ST I WA 2jp, 980310501 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 12 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� BFH3088 sTArI WAurN# 5J6YH18533L009967
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# Rom ro
TRLR. TRLR 3 7 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2003 HOND ELEMEN DAMAGE YES NO ✓ YES NO✓
REGISTERED OWNER INFO CHRISTOPHER CORTEZ 19835121ST AVE SE KENT WA 98031 D:2069451651 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI IN NSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
ve'CLe CHARGE 1 5 36
LEGALLY YEs❑NO CITATION# 3AO081054 IMPROPER LANE USAGE o aorrom
15❑ 1NDIING 6
UNIT 02 MOTOOR CYCLE ❑ PEDESTRIAN ❑ OWNER
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME MCCARTNEY FIRST NAME DANIEL MIDDLE S
INITIAL
17❑ STREET ❑', 1420 NW GILMAN BLVD STE 2 CITY' lSSAQUAH ST WA ZIP 980275333 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 DRIVER'S STATE WA SEX M D.Q.B. 12 _ 19 _ 1959 39
LICENSE# MMDDYY
HELMET I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CBW2163 TAre WA VIN1t WBAV8335X6PS16606
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2006 MAKE BMW/ MODEL 330 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO DANIEL MCCARTNEY 1420 NW GILMAN BLVD STE 2 lSSAQUAH WA 980275333 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE I PORGY#E CO PROGREESIVE 953619465IN 1GQV'""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
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. ED40385
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2250
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'
blk 2 lan4 4 gry 1/suv lane change
Within the city limits of Renton/King/WA I responded to a 2 car crash near the intersection of N 4th St
and Park Ave N.
I contacted the driver of unit 2 who told me he was in lane 4 when unit 1 changes lanes into the side
of him. He did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by picture WADL, who told me he was in lane 3 and made lane
change into the side of unit 2. He did not complain of injury and damages did not require a tow truck.
Unit 1 was cited via complaint Ref RCW 46.61.140 Improper Lane Usage.
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 3/1/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-02-23 06:02 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 3/7/2023 3:12:32 PM
BADGE OR ID# 2517 OR]#' [ WA0171300 TIME POLICE DISPATCHED; 2:92 Pry TIME POLICE ARRIVED',2:18 PM
PART I PAGE IT]OF
REPORT NO. ED40385 CASE# ' 23-2250 DATE AND TIME 02/24/23 14:05
OF COLLISION
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