HomeMy WebLinkAbout23-2553 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED40386 170
27
COLLISION REP FIT 1591971
CASE 23-2553 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 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# ❑
cowsloN 03 - 1-- 2023 0847 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
ROUSER WAY N
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a BRONSON WAYN
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2538784281 0 3 30
6� LAST NAME COTTINGHAM FIRSTNAME BRETT MIDDLE P 1 2 31
INITIAL
STREET ❑ 1600E SW DASH POINT RD#1066 CITY FEDERAL WAY ST WA 2jp, 980234530 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 05 1— 14 — 1977 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� D64985A sTArI WA urN# 3GCPDAEK7NG541312
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 3 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 3 34
13 2022 CHEV SILVER DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO ROADSAFE TRAFFIC LP 4001 LEADENHALL RD MOUNT LAUREL NJ 08054 VEHICLE NO. 1 ❑
FE
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME. 4
IN EFCT &POLICY# 9TOP
ve FE CHARGE 1 5 36
LEGALLY re6 No CITATION# 3AO081055 IMPROPER LANE USAGE o aorroM
15❑ STANDING 8 7 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4255234655
16 2
LAST NAME GARCIA FIRST NAME ABRAHAM MIDDLE N
INITIAL
17❑ STREET ❑', 12652 SE 170TH ST CITY' RENTON ST WA ZIP 980586114 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs❑NOF YEs❑NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 11 O6 _ 1997 El 39
LICENSE# MMDDYY
WELMET INJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CCV9757 TAre WA VIN# 1C46JWDG3CL247628
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2012 MAKE JEEP MODEL WRANGL STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ABRAHAM GARCIA 12652 SE 170TH ST RENTON WA 980586114 D:4255234655 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 952300331IN IUQI
'E""LE ❑ ,J� CITATION# CHARGELGALYYES N`L J25
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. ED40386
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2553
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 03-02-23 09:35 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 31712023 3:24:11 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 8:50 AM TIME POLICE ARRIVED',8:56 AM
PART I PAGE IT]OF 4�
REPORT NO. ED40386 CASE# 23-2553 OF COLLISION
03/02/23 08:47
OF CbLLI510N
NARRATIVE
wht jeep lane 2 rt wht trk/1 lane 3 rt to 405
CC
Within the city limits of Renton/King/WA I responded to a 2 vehicle crash at the intersection of Houser
Way N and Bronson Way N.
I contacted the driver of unit 2 who told me he was NB Houser to EB onto Bronson when he was hit in
the side by unit 1. It pulled his front bumper out and away from the front of his Jeep. He did not
complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he didnt know where unit 2
came from that he must have been on the sidewalk because he was just trying to merge onto SB I-
405 and unit 2 came out of nowhere. He did not complain of injury and damages did not require a
tow truck.
I cited unit 1 ref RCW 46.61.140 Improper lane usage 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 3/2/2023
PAGE 3 OF 4
REPORT NO. ED40386 CASE# 23-2553 DATE AND TIME 03/02/23 08:47
OF COLLISION
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