HomeMy WebLinkAbout24-3041 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-3041 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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-- 2024 1439 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW GRADY WAY BLOCK NO. e✓ 621
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 180 00 FMILES EET ❑ S ❑ W❑ RAYMOND AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:2533254861 0 11
30
6� LAST NAME SAYLOR FIRSTNAME KOSTINI-OSHAN MIDDLE K 0 4 31
INITIAL
STREET ❑, 221 STANFORD AVE#237 1 CITY CARBONADO ST WA 2jp, 983238500 z
'NEWADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3❑10 9❑ P1 ATE 14 CHZ3414 BTAT WA VIN# KNAFE122985583809
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 7 $ 34
13 2 2008 KIA SPECTR DAMAGE YES NO �MEYER YES : NO✓
REGISTERED OWNER INFO KOSTINI-OSHAN SAYLOR PO BOX 237 CARBONADO WA 98323 D:2533254861 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE to BOTTOM 5 36
LEGALLY, res No CITATION# 4A0078057,4AO078057 OP MOT VEH W/OUT INSURANCE,
15❑ STANDING 6
MOTOR PEDAL-: PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑ ❑ PEDESTRIAN ❑ ❑ D:2067434142
VEHICLE CYCLE OWNER YES�/ NO
16 2
LAST NAME NDAGWATHA FIRST NAME MARY MIDDLE N
INITIAL
17❑ STREET ❑', 1307 S 251ST CT CITY' DES MOINES ST' WA ZIP 98198 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES�NOF INTERLOCK YEs❑NOF YES
❑No❑ 11
19 F] LDI IVER # STATE WA ]SEX IF M .C... 05 _ 02 _ 1986 El 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 1
USE CLASS ❑
21❑ LICENSE I BZE6640 TATe WA vIN# JT2BF28K9W0108286
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 1998 MAKE TOYT MODEL CAMRY STYLE VEHICLETOWED TO BLIN TOWEDII GOV HI �44
24 DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO MARYNDAGWATHA 1307 S 251ST CT DES MOINES WA 98198 D:2067434142 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. I 9TOP
'E""LE ,J� CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES❑ N`L I
$ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE65038
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3041
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 03-28-24 11:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 4/3/2024 5:49:52 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 2:39 Pry TIME POLICE ARRIVED',2:46 PM
PART I PAGE IT]OF 4�
REPORT NO. EE65038 CASE# 24-3041 OF COLLISION
03/20/24 14:39
OF CbLLI510N
NARRATIVE
tan /2 In chg in her lane blk/1 bald tire 28p skid into
CC
Within the city limits of Renton/King/Wa I responded to a a 2 car blocking crash at SW Grady Way @
Raymond Ave SW.
I contacted the driver of unit 2 who told me she was eastbound at about 35 mph in lane 2 and
changed lanes into lane 1. She said she had been established in that lane when she was hit from
behind by unit 1. It spun her car out, up and over the sidewalk and over a small embankment. She
did not complain of injury and damages did require a tow truck.
I contacted the driver of unit 1 ID'd y her picture WADL. She told me she was eastbound going with
the flow of traffic. She described unit 2 cutting her off. However, unit 1 left about 80 feet of tire mark
prior to impact and about 10-12 feet of tire mark post impact. When I asked her what the flow of
traffic meant she told me between 35-40mph. She was unable to provide valid proof of insurance for
her vehicle.
Based on the length of tire marks and description of the collision and damage to the vehicles I cited
unit 1 ref RMC 10-12-25 Driver Inattention and ref RCW 46.30.020 No valid proof of insurance 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 3/27/2024
PAGE 3 OF 4
REPORT NO. EE65038 CASE# ' 24-3041 DATE AND TIME 03/20/24 14:39
OF COLLISION
W K
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SY
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