HomeMy WebLinkAbout23-3107 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
CASE 23-3107 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 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 1335 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
OAKESDALE AVE SW
e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW41ST ST
0 4 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD MET PHONE 0 1 30
6� LAST NAME BURGHER FIRSTNAME SUSAN MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 22240 24TH AVE S APT E41 CITY DES MOINES ST WA 2jp, 981988812 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 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� AMT2776 sTArI WAVrN# 2T18U4EE0DCO22875
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 5 33
12 3 5 VIN#' UIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE $ 34
13 r 2013 TOYT COROL DAMAGE YES Z NO ` RS YES NO✓
REGISTERED OWNER INFO SUSAN BURGHER 2224124TH AVE S EE41 DES MOINES WA 98198 D:2068700664 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
YES No CITATION# 3AO081088 FAIL YIELD LEFT TURN MOTOR o eorrom
15❑ NDING 6
1.� MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
GNIT 02 � ❑ PEDESTRIAN ❑ ❑
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME MESKIMEN FIRST NAME JARED MIDDLE M
INITIAL
17❑ STREET ❑', 3002 217TH AVENUE CT E CITY LAKE TAPPS ST WA ZIP 983915629 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs❑NOF YEs❑NO❑
19 LICENSE# STATE WA SEX M M .C... 11 18 _ 1987 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I 0001953 TAre WA VIN1 1FTEW1EP1FFB83740
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2015 MAKE FORD MODEL F150 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JARED MESKIMEN 3002217TH AVENUE CT E LAKE TAPPS WA 98391 D:4068557798 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IU�'E""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. ED43183
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3107
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'
red sedan/1 left turn fron 41 to sb oakes unit 2 gry lane 2
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Oakesdale Ave SW at SW 41 st St.
I contacted the driver of unit 2 who told me he was south on Oakesdale when unit 1 pulled from SW
41 st street and drove into the side of his truck. He did not complain of injury and damages did not
require a tow truck, but the damages were heavy to unit 2.
1 contacted the driver of unit 1 ID'd by her picture WADL. She did not provide a description of the
crash, but told me she was shaken up and never saw unit 2. She did not complain of injury and
damages did require a tow truck.
I cited unit 1 ref RCW 46.61.185 FTYROW left turn 2 car 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 3/16/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 03-16-23 03:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 311712023 10:01:52 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1:36 PM TIME POLICE ARRIVED',1:41 PM
PART I PAGE IT]OF
REPORT NO. ED43183 CASE# ' 23-3107 DATE AND TIME 03/16/23 13:35
OF COLLISION
;Z) rats
r
f
PAGE 3 OF 3