HomeMy WebLinkAbout23-7929 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7929 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 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 07 - 11 - 2023 1342 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
N 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ ❑ FEET e S ❑ W e BURNETT AVE N
0 1 29
UNIT MOTOR
E Z CYVEHICCLE ElDDAMYESA✓NOESHOLDMET PHONE 0 1 30
6� LAST NAME OUCH FIRSTNAME AMANDA MIDDLE R 1 4 31
INITIAL
STREET ❑I 124 4TH AVE SW APT 4 CITY PACIFIC ST WA 2jp, 980471393 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO INTERLOCK YES NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 5 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ LICE
BVM9627 STATE WA VIN# 2T3J1RFV1LC135448
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FR.. ro
TRLR. YRLR. 5 1 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 3 ] 34
13❑2 2020 TOYT RAV4 DAMAGE YES 0NO d9k�MEYERS vs❑ No✓
REGISTERED OWNER INFO AMANDA OUCH 1244TH AVE SWAPT 3 PACIFICWA98047 D:2532040385 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE E CO SAME. �m,
IN EFFECT &POLICY#LEGA LE CHARGE 36
LE—Lv res❑NO CITATION# 3A0329689 FAIL STOP AT STOP
15❑ STAIN.D'ING 8 7 6
UNIT a2 VE IMOTOCLE CYCLE ❑ PEDESTRIAN ❑ OWNER
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME VU FIRST NAME AI-VAN MIDDLE I H
INITIAL
17❑ STREET ❑', 26628 163RD CT SE CITY' COVINGTON ST WA ZIP 980428215 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 LDI IVER # STATE WA ]SEX IF M .C... 10 _ 27 1975 0 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I BPX5333 TATe WA VIN# 5YJ3E1EB6KF388502
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE ILER# STATE El
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR 2019 MAKE TESL MODEL MODELS STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI �44
24❑ DAMAGE YES✓ NO GENE MEYERS YES NO✓
REGISTERED OWNER INFO AI-VAN VU 26628163RD CT SE COVINGTON WA 98042 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
VE""LE ❑ N`L J
,J� CITATION# CHARGE to BOTTOM
LEGALLY YES
25 ' e
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. ED82459
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7929
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PORCARO REBECCA
(IAST FIRST,
ADDRESS&PHONE# D O.B.
2067210425 SEX' U MMDDYYYY -❑
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ a POS. USE CLASS
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# D O E4
SEX MMD DO V
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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 07-11-23 02:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 712412023 11:25:26 AM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED ?:4Y Pry TIME POLICE ARRIVED',1:46 PM
PART I PAGE IT]OF 4]
TIME
REPORT NO. ED82459 CASE# 23-7929 OF COLLISION07/11/23 13:42
NARRATIVE
wht suv nb..... wht tesla lane 1 wb
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of N
4th St at Burnett Ave N.
I contacted the driver of unit 2 who told me she was westbound lane 1 on N 4th St when unit 1 pulled
from a stop sign and they crashed. She did not complain of injury and damages required a tow truck.
I contacted the driver of unit 1 ID'd by her picture WADL. Unit 1 told me she was northbound on
Burnett Ave N and that it was hard to see around traffic, but she went anyhow and crashed with unit
2. She did not complain of injury and damages did require a tow truck.
I contacted listed Witness who said she was stopped east of Burnett in traffic. She said she watched
as traffic was still westbound when unit 1 cross 4 lanes of traffic when the two cars crashed.
I cited unit 1 ref RCW 46.61.190, FTROW from Stop Sign 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 7/11/2023
PAGE 3 OF 4
REPORT NO. ED82459 CASE# ' 23-7929 DATE AND TIME 07/11/23 13:42
OF COLLISION
nts
PAGE 4 OF 4