HomeMy WebLinkAbout23-4390 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-4390 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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 CITY#
COLLISION.. 04 - 19 - 2023 0824 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
140TH WAY SE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e SE 142ND PL SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4255259696 0 6 30
6� LAST NAME STILWELL FIRSTNAME RONALD MIDDLE L 1 2 31
INITIAL
STREET ❑ 17534 151 ST AVE SE UNIT 10-12 CITY RENTON ST WA 2jp, 980588803 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEX'M MM DAY' 12 1— 13 — 1969 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ PI ATFBit 975KZY sTATI WA urN#' 3FAFP3134YR198440
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2000 FORD FOCUS DAMAGE vEs 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO RONALD STILWELL 17534151STAVE SE UNIT 10-12 RENTON WA 980588803 D:4255259696 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO ALLSTATE 807241513 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3A0329651 INATTENTIVE DRIVING )o sorrow
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
(SNIT U2 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:4255913253
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME ARMITAGE FIRST NAME RACHEL MIDDLE I E
INITIAL
17❑ STREET ❑', 14401 SE PETROVITSKY RD APT B CITY RENTON ST WA ZIP 980588910 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED ❑ 38
INTERLOCK YES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 D IVEW #
I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CBN3218 TATe WA VIN1i 3HGGK5H62LM734155
❑ 41
PLATE#
42
22❑ PLATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2020 MAKE HOND MODEL FIT STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO RACHEL ARMITAGE 14401 SE PETROVITSKYRD APTB RENTON WA 980588910 D:4255913253 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO USAA 018175305RIN I 9TOP
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED55409
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4390
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 couope slow fro red blk coupe rear/unit 1
CC
Within the city limits I responded to a 2 car blocking crash at the intersection of 140 th Way SE and
142nd PL SE.
I contacted the driver of unit 2 who told me she was slowing for the red light and was hit from behind
by unit 1. She did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was nb on 140th Way lane 1
when he believed the light was yellow when unit 2 was slowing and didnt notice she was actually
stopping. He said he was braking but slid into the back of unit 2. He did not complain of injury and
damages did require a tow truck.
I cited unit 1 via complaint ref RIVIC 10-12-25 Driver Inattention 2 car crash.
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 4/19/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 04-19-23 10:19 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 412812023 2:28:41 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 8:24 AM TIME POLICE ARRIVED 8:32 AM
PART I PAGE IT]OF
REPORT NO. ED55409 CASE# 23-4390 DATE AND TIME 04/19/23 08:24
OF COLLISION
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