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Home My WebLink About24-054 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 ❑ ✓❑ RESULTED ❑ CASE z4-os4 2 INTERSTATE CITY STREET FIRE 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AGENCI 4150 3 HIT 8 RUN ✓ CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION.. 01 - 1-- 2024 1546 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE PETROVITSKY RD BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 128THAVESE 0 1 29 UNIT 01 VEHICLE MOTZ PEDAL-ORCYCLE ElDESA✓NHORESHOLD MET PHONE 0 8 30 6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31 INITIAL STREET ❑ CITY RENTON ST ZIP 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCK YES NO YES No 8❑ LIRCIENSRE# STA fE I SEX u MMDOOYY '❑- 1 1 2 32 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES 2❑ 3 10❑ P1 ATES14 BWP8636 STATE WA VIN# 1C4PJMKLB8tD555677 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FR.. ro TRLR. TRLR 7 3 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34 13❑2 2020 JEEP CHERO DAMAGE YES NO ✓ YES❑ NO✓ REGISTERED OWNER INFO VENNSSA KALASIKA 17701108TH AVE SE#29 RENTON WA 98055 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LEGALLv YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STAIND'ING 6 UNIT 02 VE IOOR CYCLE ❑ PEDESTRIAN ❑ PROPE OWNFRRTY ❑ DYES✓ NO OLD MET PHONE 16 a LAST NAME HALINGSTAD FIRST NAME DAVID MIDDLE W INITIAL 17❑ NEW STREETRE67 13412 SE 172ND PL CITY RENTON ST WA ZIP 980586155 37 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑ 19 LDIIVEW # STATE WA SEX M MMDDYY 08 _ 28 _ 1961 El 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES ❑ 40 USE CLASS NECK ❑21❑ PLATE# CCN9360 TATE 41 WA VIN 1 3FMCR9C67NRD30180 4 42 22❑ PILER LATE# STATE pLATE# STATE TRLR 23❑ UIN#. N#. 43 RLR 'I VEH YEAR 2022 MAKE FORD MODEL BRONCO STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES✓ NO BANKERS YES NO✓ REGISTERED OWNER INFO CONTRACT FURNISHINGS MART 3621139TH AVE NE LAKE STEVENS WA 98258 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIAIN BILITY INSURANCE INSU PORKY#E CO SAME. 9TOP vE""LE CITATION# CHARGE i o BOTTOM LEGALLY YES Nu 25❑ s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 M.LEVERTON 2517 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE37455 COLLISION REPORT III III III III III 111 1591972 CASE# 1 24-054 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 I AIRBAG RESTR. EJECT HELMET NJURY 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 01-04-24 06:53 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 11512024 9:29:35 AM BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 3:47 PM TIME POLICE ARRIVED',3:52 PM PART I PAGE IT]OF REPORT NO. EE37455 CASE# 24-054 OF COLLISION 01/02/24 15:46 OF CbLLI510N NARRATIVE blue cherke/1 rear 2 orange bronco red sedan/3 lane 2 Within the city limits of Renton/King/Wa I responded to a 3 car hit and run crash near the intersection of SE Petrovitsky Rd at 128th Ave SE. When I arrived only one car/unit 2 was on scene. Unit 2 driver told me he was stopped for the traffic/traffic light when he was hit from behind by unit 1. Unit 2 did complain of neck pain but refused treatment by Renton Fire who was also onscene. He told me a tall thin black female was the driver of unit 1. They agreed to pull off Petro and onto 128th. He said a small red sedan/unit 3 and a blue Cherokee/unit 1 pulled off onto 128th Ave SE on the south side of the intersection. Officer Brown drove around the area to locate unit 1 and unit 3 with negative results. Unit 2 said he did not notice either vehicle leaving the dead end neighborhood. Unit 2 vehicle was towed for damages. The driver of unit 1 did not match the RO as described by unit 2. Unit 2 described unit 1 driver as tall. Unit 2 is 6'8 so for him to describe someone as tall, and the RO at 5'5 didnt match. An area check at unit 1 RO address was negative. 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 1/2/2024 PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EE37455 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-o54 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE t_"J � PEDESTRIAN YES NO � 8 29 LAST NAME : UNKNOWN FIRST NAME , MIDDLE INITIAL 30 STREET FS�� CITY RENTON ST ZIP 6 NEW AnDR CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31 INTERLOCK YES[:]NO zERLOCK YES❑N0� YES N DRIVER'S STATE I SEX U M��DYSYv' —� 2 LICENSE 7F-ION DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWE E T SABLIN TOWED BY anvi vEH1C P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO.]NEW] RENTON J 9 33 12 � SHADE IN DAMAGED AREA 34 FROM TO ((ABILITY INSURANCE INSURANCE CO IN EFFECT &POLICY# tGQO VEHICLE 34 13LEGALLY YESZ NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 36 15 LAST NAME FIRST NAME : INITIAL MIDDLE ❑ STREET 16 NEn+AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO ❑ 17 5 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ [441 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# 1 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. M.LEVERTON 01-04-24 06:53 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OI BADGE 2517 O#I',WA0171300 APJOHNSON 11512024 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EE37455 CASE# ' 24-054 DATE AND TIME 01/02/24 15:46 OF COLLISION Ats 1 � +y PAGE 5 OF 5