HomeMy WebLinkAbout22-13131 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. ED14493 170
27
COLLISION REP FIT 1591971
CASE 22-13131 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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#
COLLISION'. 12 - 1-- 2022 1235 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY BLOCK NO. e✓ 14000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ❑ FEET e S ❑ W e 140THWAYSE
❑
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:4252263882 0 81
30
6� LAST NAME PICKLE FIRSTNAME WANDA MIDDLE M 1 2 31
INITIAL
STREET ❑, 16843 SE 134TH ST CITy RENTON ST WA ZIP' 980597021 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 . EJECT 1 HELMETU E 2 CLASS INJURY6 [NATURE OF INJURIES
C/O CHEST PAIN AND HEADACHE z❑
3
10[1Pi ATNES# AJU7995 sTAr WAv N# JHLRD78596C011657
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM To
TRLR. TRLR $ 3 33
12 $ 0 VIN#' VIN#
ROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE J 9 34
13 2 2006 HOND CR-V SV DAMAGE YES NO MEYERS YES[:] NO✓
REGISTERED OWNER INFO LESLIE PICKLE 16843 SE 134TH ST RENTON WA 98059 D:4252263882 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO STATE FARM 080 5656-F15.47D 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# W22067720 INATTENTION I o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO OLD MET D:4255182774
16 a
LAST NAME ROYAL 77771 FIRST NAME ROSITA MIDDLE T
INITIAL
17 NEW STREETREs7 10705 SE 236TH PL CITY KENT ST WA ZIP 980313341 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX F D.C... 08 _ 08 _ 1948 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# ARM0422 TArE WA VIN# 41
2HKRM4H55DH629412 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2013 MAKE HOND MODEL CR-V STYLE SI/ VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO ROSITA ROYAL 10705 SE 236TH PL KENT WA 98031 D:4255182774 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 3582531-Bit-47BIN STOP 5
VE""LE CITATION# CHARGE
YES N
25 i o BOTTOM
LEGALLY u
❑ a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED14493
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13131
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) AGUAS ESPERANZA T
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
322 ROSARIO PL SE RENTON WA 980596768 4252089146 SEXi F MMDOYyry 01 - 20 - 1950
PASSENGER I�I WITNESS UNIT# 2 P�5 3 AIRBAG 2 RESTR. 4 EJECT ? HELMET INJURY NATURE of INJURIES
L�!1 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.Q.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.
MATTHEW NUGENT 12-13-22 01:10 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.MORRIS 2613 1211412022 3:54:02 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED; 12:36 PM TIME POLICE ARRIVED',12:39 PM
PART I PAGE IT]OF 4�
REPORT NO. ED14493 CASE# 22-13131 OF COLLISION
12/12/22 12:35
OF CbLLI510N
NARRATIVE
22-13131
On 12/12/2022 at approximately 1236 hours, I was dispatched to a blocking vehicle collision at the
intersection of Maple Valley Highway and 140th Way SE, within the City Limits of Renton, County of
King, State of Washington.
While en route, Dispatch advised that two vehicles were involved in a collision at the intersection and
were blocking. Dispatch advised that the Renton Regional Fire Department would be simultaneously
dispatched due to one of the involved parties complaining of pain. Sergeant S. Woodward had arrived
on scene prior to my arrival.
Upon my arrival, 1 contacted the involved parties and confirmed the driver of Unit#1 was complaining
of chest pain. Renton Fire later responded and evaluated all involved parties at the scene. 1 collected
each involved party's driving information and their independent recollection of the incident.
The driver of Unit#1 stated she was the sole occupant of her vehicle and was traveling northbound
on 140th Way SE approaching the intersection of Maple Valley Hwy in lane 1 of 3. The driver of Unit
#1 stated that she was intending to turn east (right-turn) to proceed east on Maple Valley Hwy. The
driver of Unit#1 did not recall what occurred before colliding with Unit#2 which happened to be
traveling in the single left-turn lane (lane 3 of 3) of WB Maple Valley Hwy. Unit#1 suffered significant
damage to the front of the vehicle.
The driver of Unit#2 stated that she and her adult passenger were traveling westbound on Maple
Valley Hwy approaching the intersection of 140th Way SE in lane 3 of 3 (left-turn lane). The driver of
Unit#2 stated that she had come to a stop at the controlled intersection which was displaying a red
light for her direction of travel. While stopped, the driver of Unit#2 noticed Unit#1 came from the
south side of the intersection and appeared to have made her turn too wide and collided with the front
of Unit#2 causing moderate damage.
Based on the above statements, I believe the driver of Unit#1 (Pickle) was the predominant factor for
the cause of collision as Pickle made an improper turn and continued over to the opposing lanes of
travel which Unit#2 was occupying causing a collision.
During my encounter with Mrs. Pickle, I noticed her asking the same questions repeatedly and even
after providing her with the same answer, she would ask the same question again, sometimes less
than a minute later. It was apparent to me that Mrs. Pickle was suffering from memory loss and based
on the assistance she needed just getting her to and from her vehicle rose questions on if Mrs. Pickle
was fit to be driving a motor vehicle. I will be issuing a DOL Driver Retest Form in Mrs. Pickle's name
due to the potential driving hazards that remain. I also issued Mrs. Pickle a written warning for
Inattention.
Unit#1 had to be impounded due to extensive damage. Unit#2 was able to be driven away without
further incident. Both involved parties were provided a copy of the Exchange of Information.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 12:13 PM 12/13/2022 Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO.! ED14493 CASE# ' 22-13131 DATE AND TIME 12/12/22 12:35
OF COLLISION
Unit#1'
Unit#2
*Diagram not to scale
.� Maple Valley Highway
0
v
cn
m
PAGE 4 OF 4