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COLLISION REP FIT 1591971
CASE 23-6619 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 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 06 - 10 - 2023 1510 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SW V/CTOR/A ST
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:9166705581 0 6 30
6� LAST NAME MITCHELL FIRSTNAME JERIMYAH MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 5607 ELAINE AVE SE CITY AUBURN ST WA Zjp, 98092 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CFU6575 sTArI WAvIN# 1G1ZD5ST7JF228178
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 1 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR 2018 CHEV MAL/BU 4D MAKE MODEL STYLE VEHICLE TOWED 0 TO ffBLINI T YMEYERS GOVT.VEHICLE 5 1 34
13 DAMAGE YES NO � YES[:] No✓
REGISTERED OWNER INFO JERIMYAH MITCHELL 5607 ELAINE AVE SE AUBURN WA 98092 D:9166705581 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14LIABILI INSURANCE INSURANCE CO PROGRESSIVE 951915389 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY Yes❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2066052339
16 a
LAST NAME MITCHELL FIRST NAME TREYVON MIDDLE M
INITIAL
17❑ NEW STREETREs7 9903 S 248TH PL APT C202 CITY KENT ST WA ZIP 98030 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK v�Esl I I NOF YEs t l NO�
19 DRIVER'S STATE WA SEX M D.O.B. 04 26 _ 1993 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CFY5584 TArE 41
WA VIN# 1N46L4EV2PN367349 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2023 MAKE NISs MODEL ALTIMA STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYERS YES NO
REGISTERED OWNER INFO RENTAL ENTERPRISE 3150 S 160TH ST STE 508 SEA TAC WA 98188 D:8333298464 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY INSURANCE INSU&PORGY#E CO HOLDINGS INSURANCE SI84 1 9TOP
IN EFFECT
"'LE ❑ N`LJ
,.I— CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES $ '
=MCGRUDER
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 01469 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73314
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6619
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRS 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.
ROBERT MCGRUDER 06-20-23 02:22 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 6/24/2023 1:09:42 PM
BADGE OR ID# 01469 ORI# WA0171300 TIME POLICE DISPATCHED 3:14 PM TIME POLICE ARRIVED 3:18 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED73314 CASE# 23-6619 OF COLLISION
06/10/23 15:10
OF CbLLI510N
NARRATIVE
Assignment:
On 06-10-2023 1 was working patrol in an assigned Renton Police unit in the City of Renton, County
of King, State of Washington. At approximately 1514 hours, I was dispatched to the Rainier Ave
S/SW Victoria Street intersection for a two vehicle Traffic Collision.
Details:
I arrived on scene and made contact with Jeriamyah C MITCHELL DOB 06-03-2007 (Unit#1 Driver).
MITCHELL said he was driving his silver 2018 Chevy Malibu (WA/LIC CFU6575) northbound on
Rainier Ave S in Lane #1 at about 35 MPH near the above mentioned location when a silver unknown
sedan changed lanes from Lane #1 causing him to maneuver into Lane #2. MITCHELL said he rear
ended Unit#2 when he changed lanes because Unit#2 was slowing down at the time.
I made contact with Treyvon M MITCHELL DOB 04-26-1993 (Unit#2 Driver). T. MITCHELL stated he
was driving his black 1999 Nissan Altima (WA/LIC CFY5584) northbound at about 35 MPH in Lane
#2 on Rainier Ave S when he was slowing down for traffic and was rear ended by Unit#1.
T.MITCHELL did not see what occurred behind him that caused Unit#1 to rear ended him.
Injuries:
There were no reported injuries.
Disposition:
Unit#1 and Unit# 2 were both totaled and towed by Gene Meyers Towing.
After gathering all of the above parties' statements and investigating the collision scene, I determined
that Unit#1 was following too closely and was unable to stop in time when an unknown vehicle
abruptly changed lanes into his lane of travel. Unit#1 had to maneuver lanes in order to avoid a
collision, but he was unable to stop in time during the maneuver causing Unit#1 to rear end Unit#2.
J MITCHELL was given a warning.
All parties were given case numbers.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by R.McGruder 11469 06-20-2022 1330 Hours.
PAGE 3 OF 4
REPORT NO. EU73314 CASE# 23-8610 DATE AND TIME 08/ 0/231510
OF COLLISION
NOTTOSME
PAGE 4 OF *