HomeMy WebLinkAbout24-204 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE# z4-zoo 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICCI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 5 6 28
TRIBAL UNITS OZ 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 1834 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 30TH ST BLOCK NO. e✓ 1600 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ VV a I405 OFF RAMP
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO ✓ D:2067108000 0 4 30
6❑ LAST NAME WEISSE FIRSTNAME MARCUS MIDDLE G 1 1 2 31
INITIAL
STREET ❑ 900 GLENNWOOD AVE NE APT 4 CITy RENTON ST WA ZIP' 980563065 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES R No
8❑ LDRIVER # STATE WA SEX'M MID
LOB 05 1- 16 - 1973 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2❑
3
10 2❑ PI ATE 14 C81414W JBTATIJ WAv N# 1 FTPW12V79F622019
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2009 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 7 34
13 4 FORD F150 PK DAMAGE YES NO ✓ YYES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VE—LL CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U—NIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES✓ NO D:2068191002
16 a
LAST NAME FRANKLIN FIRST NAME KERI MIDDLE I G
INITIAL
17 STREET IERDEEN AVE NE CITY' RENTON ST WA ZIP 98056 4❑ 37
NEW ADOREs�' 1500 AB
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.O.B. 05 _ 31 1976 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# AUT7461 TATE WA VIN# 41
SXYKTDA67CG302345 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2012 MAKE I(I/� MODEL SORREN STYLE UT DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO✓ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGELLAREA
LIABILITY
INSURANCE I PORGY#E CO ALLSTATE 964524097IN 1 VE—LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s 7 6
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE42058
COLLISION REPORT III III III III III 111
1591972 CASE# 1 24-204
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TINKER JUNKO N
(LAST FIRST,
ADDRESS&PHONE#
900 GLENNWOOD AVE NE APT 4 AP RENTON WA 980563065 2066791311 SEXi F MMDOYyry 07 - 15 - 1971
PASSENGER Z WITNESS❑"UNIT# SOS 3 AIRBAG 2 RESTR. q EJECT HELMET INJURY NATURE OF INJURIES
USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT 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.
BRYAN GROZAV 01-07-24 12:21 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 111912024 2:12:07 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 6:41 PM TIME POLICE ARRIVED]6:51 PM
PART I PAGE IT]OF 4�
REPORT NO. EE42058 CASE# 24-204 OF COLLISION
01/06/24 18:34
OF CbLLI510N
NARRATIVE
CASE 24-204
This incident was captured on my body worn video camera and/or in-car dash camera. This report is
a summary of events that occurred and is not an exact sequencing of events.
On Saturday January 6th, 2024, at approximately 18:41, 1 responded to a 911 call regarding a two-
vhicle collision near AMPM located at 1616 NE 30th Street within the City of Renton, King County,
Washington.
'CALL REMARKS: 2 MVA, NI/NB .. PULLED TO EB SHOULDER .. DRIVER OF VEH #1 DOESN'T
HAVE INS
UNIT ONE: WHITE 2009 FORD F150 WASHINGTON LICENSE: C81414W
UNIT ONE DRIVER: MARCUS G WEISSE (DOB: 5.16.19873)
UNIT TWO: GREY KIA SORENTO WASHINGTON LICENSE: AUT7461
UNIT TWO DRIVER: KERI G. FRANKLIN (DOB: 5.31.1976)
1 arrived on scene and contacted the involved parties on the shoulder of NE 30th Street in front of the
listed location. 1 confirmed there no injuries, and no one requested aid. Marcus reported the following;
he was traveling east on N 30th Street and stopped at the stop sign at the off ramp. He proceeded
forward and crashed into Keri as she was making a left turn onto N 30th Street from 1405 south bound
off ramp. Marcus indicated he was at the stop sign first before Keri. Marcus did not have valid vehicle
insurance at time of the incident.
Keri reported the following; she exited 1405 and was making a left turn onto N 30th Street from the
south bound off ramp. After stopping at the stop sign, she proceeded with her left turn but was
involved in a crash with Marcus. Keri indicated she was stopped at the stop first before Marcus and
believed she had the right of way.
I provided Marcus and Keri a copy of the SECTOR exchange of information form. Both vehicles had
minor damages and able to drive.
This concludes my involvement in this case.
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 B. Grozav #12489 on 1.06.2023 at 23:59 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE42058 CASE# ' 24-204 DATE AND TIME 01/06/24 18:34
OF COLLISION
'NE, 30ST
PAGE 4 OF 4