HomeMy WebLinkAbout23-2750 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED41060 170
27
COLLISION REP FIT 1591971
CASE 23-2750 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
0 5
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 03 - 07 - 2023 1416 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BRONSON WAY N BLOCK NO. e✓ 1100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 175 00 FMILES EET e S ❑ E e PARKAVEN
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:4258303943 0 11
30
6� LAST NAME WHITE FIRSTNAME TERRY MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 25374 SE 279TH PL CITY MAPLE VALLEY WA
NEW ADDRESS ST Zjp, 980382028 z
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEX'M MM DAY' 10 1— 16 — 1975 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� C40718K sTArI WAurN# 1FDUF5GT4HDA02086
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 3 1 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 2017 FORD F550 DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO NATIONAL CONCRETE CUTTING INC 7715 PACIFIC HWYE MILTON WA 98354 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLY, YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN."' 8 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
[:]I DYES✓ NO OLD MET PHONE
16 a
LAST NAME MARTIN FIRST NAME DESTINI MIDDLE I F
INITIAL
17❑ STREET ❑', 906 25TH AVE CITY SEATTLE ST WA ZIP 981224906 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 LICENSE# STATE WA ]SEX IF M .O.B. 01 10 _ 1980 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 2 EJECT 1 USE CLASS ❑
21❑ LICENSE I BKS5464 TAre WA VIN# KMHFC46F47A234680
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2007 MAKE HY(JN MODEL AZERq STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO GLORIA MARTIN 90625TH AVE SEATTLEWA98122 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME, IUR'E""LE
❑ ,J� CITATION# CHARGELGALYYES N`LJ
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. ED41060
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2750
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'
slv/2 lane 1 truck lane 1 swing 2 vrash
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at about the 1100 block
of Bronson Way N.
I contacted the driver of unit 1 who told me he wanted to turn his large work truck into a small
driveway on the north side of Bronson Way. He said he was in lane 1 and swung his truck wide into
lane 2 so he could clear the narrow driveway apron. In the process the car behind him/unit 2 drove
into the sie of his truck and they were stuck together blocking the road. He did not complain of injury
and damages did not require a tow truck.
Unit 2 was still inside the car with a portion of the driver side of her car under unit 1. She was being
checked by Renton Fire at the time and did not provide any additional information ref the crash. She
was released by Renton Fire on scene. Damages did not require a tow truck.
Information/Insurance 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 3/8/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-08-23 09:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 3/9/2023 9:22:45 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 2:98 Pry TIME POLICE ARRIVED 2:20 PM
PART I PAGE IT]OF
REPORT NO. ED41060 CASE# ' 23-2750 DATE AND TIME 03/07/23 14:16
OF COLLISION
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