HomeMy WebLinkAbout22-13282 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 22-13282 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE DF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 12 - 1-- 2022 1739 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW GRADY WAY BLOCK NO. e✓ 1300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 282 00 FMILES EET e S ❑ W e OAKESDALE AVE SW
0 1 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
,/No D:4257576318 0 81
30
6� LAST NAME GARCIA FIRSTNAME YAHAIRA MIDDLE K 1 1 2 31
INITIAL
STREET El 1141 GLENNWOOD AVE NE UNIT A CITY RENTON ST WA 2jp, 980563192 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
8 LICIENSE# STATE yyq SEX'F MM ovY' 01 - 22 - 2004 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 aTES� C20032Y sTAr� WAurN# 1 FTFX1 ET36F650246
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE g 9 34
13 2 2011 FORD F150 PK DAMAGE vEs ONO f �AWkkRS vEs❑ No,/
REGISTERED OWNER INFO BRUNO DONZ =RAMIREZ 1429 E 46TH STAPT 37 TACOMA WA 98404 D:4257576318 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO FARMERS 538721760 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LE ALLv YES❑NO❑ CITATION# W22067725 INATTENTION 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
U�iT VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:2068839054
16 a
LAST NAME DAD FIRST NAME TAM MIDDLE
INITIAL
17❑ STREET IS❑' 10332 51 ST AVE S CITY' SEATTLE ST WA ZIP 981782131 4❑ 37
NEW ADDRES
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER # STATE WA SEX M M D.C.B.
04 � 02 _ 1968 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# C31286T TArE 41
WA VIN# 3TMCZ5AN2LM288633 1
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE TOYT MODEL TACOMA STYLE PK VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO TAM DAD 1033251STAVE S SEATTLE WA 98178 D:2068839054 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO NATIONWIDE 7246JO02123IN STOP
'E""LE CITATION# CHARGE
LEGAL
25 i o BOTTOM
0(
LY YES Nu
❑ s
=UGENT
PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED19073
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13282
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DAO THUAN T
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
10332 51ST AVE S SEATTLE WA 981782131 2068839054 SEX M MMDovyvv 02 - 03 - 2003
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS, 3 2 4 1 USE 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) WANG DAJUN
ADDRESS&PHONE# D O E4
949 ABERDEEN AVE NE APT C109 RENTON WA 980564805 4255168958 SEX' M MMDDvvvv 08 _ 01 _ 1962
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 3 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
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.
MATTHEW NUGENT 12-20-22 06:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 12/27/2022 12:48:53 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 5:40 PM TIME POLICE ARRIVED 5:54 PM
PART I PAGE 2�OF❑
REPORT NO. ED19073 CASE# 22-13282 OF COLLISION
12/15/22 17:39
OF CbLLI510N
NARRATIVE
22-13282
On 12/15/2022 at approximately 1740 hours, I was dispatched to a non-injury and blocking vehicle
collision at the intersection of Oakesdale Ave SW and Southwest Grady Way, within the City Limits of
Renton, County of King, State of Washington.
While en route, Dispatch advised the involved vehicles were blocking the eastbound right lane.
Upon arrival, I confirmed there were no complaints of injury from either of the involved parties. There,
I collected each of the involved parties driving documents and their independent recollection of the
events leading up to the collision.
The driver of Unit#1 said she was the sole occupant of her vehicle and was traveling eastbound in
about the 1200 block of SW Grady Way approaching the intersection of Oakesdale Ave SW in lane 1
of 2. The driver of Unit#1 stated she was traveling directly behind Unit#2 and saw as Unit#2 was
stopped or slowing for traffic. Unit#1 stated that she saw Unit#2 had come to a stop in front of her.
Unit#1 was unable to stop in time subsequently colliding with the rear of Unit#2 causing significant
damage to the front of Unit#1.
The driver of Unit#2 said he and his adult passenger were also traveling eastbound in about the
1200 block of SW Grady Way approaching the intersection of Oakesdale Ave SW in lane 1 of 2. The
driver of Unit#2 stated he was stopped or slowing for traffic. Unit#2 came to a stop for queued traffic
at the intersection ahead. The driver of Unit#2 stated that while stopped, Unit#1 collided with the
rear of Unit#2 causing significant damage to the rear of Unit#2. As a result of the initial collision, Unit
#2 was pushed forward and collided into the rear of Unit#3 causing additional damage to the front of
Unit#2.
The driver of Unit#3 said she and her adult passenger were traveling eastbound in about the 1200
block of SW Grady Way approaching the intersection of Oakesdale Ave SW in lane 1 of 2. The driver
of Unit#3 stated she was stopped for queued traffic at the intersection ahead. The driver of Unit#3
stated that while stopped, Unit#2 collided with the rear of Unit#3 causing minor damage to the rear
of Unit#3.
Based on the above statements, I determined that the Driver of Unit#1 (Garcia) was the predominant
factor for the cause of collision due to inattention causing a collision. I issued Garcia a written warning
for Inattention.
Unit#1 had to be impounded due to extensive damage. Both Unit#2 and Unit#3 were able to be
driven away without further incident. An exchange of information was provided to all involved parties.
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 6:07 PM 12/20/2022 Renton, King County, WA.
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. ED19073
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 22-13282
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 DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO
D:4255168958
0 8 29
LAST NAME ZHAN FIRST NAME FENG MIDDLE
INITIAL
STREET 30
NEW AnnRFSP 949 ABERDEEN AVE NE APT C109 CITY RENTON ST WA ZIP 1 980564805
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED
INTERLOCK YEs NO zERLOCK YES❑N0� YEs N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv', 04 TO]
- 1964
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BGH5640 TAr Wq VIN# 4T1BE30KX5U984086
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 3 5 VEH.YEAR MAKE MODEL STYLE VEHICLE TOME E T SABLIN TOWED BY anvi vEH1C E FROM TO
2005 TOYT CAM4D 4D DAMAGE YES NO YES NO
REGISTERED OWNER INFO.TIANYE WANG 949 ABERDEEN AVE NE APT C109 RENTONWA98056 D:4255168958 J 9 33
SHADE IN DAMAGED AREA
12 z 3 4
FROM TO
LIABILITY INSURANCE INSURANCE CO METROMILE 42.59826P-04.O1 GQO
IN EFFECT &POLICY# 1EHICLE 34
13LTAGFlGEGALLY YES NO❑ CITATION# CHARGE
STANDING S} 8 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER
RTY YES[—]AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE
36
❑
STREET
16 ST An FE CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YEs NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY -� II
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38
USE CLASS
19 ❑ LICENSE TAr VIN# 39
PLATE#
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ ❑ 41
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# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGALLv
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.
MATTHEW NUGENT 12-20-22 06:36 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 � OI BADGE 11498 O#I',WA0171300 APJOHNSON 12127/202 PAGE F41 OF F
3000-345-013(R 11118)
REPORT NO.! ED19073 CASE# ' 22-13282 DATE AND TIME 12/15/22 17:39
OF COLLISION
w
Via Q
QC
14-v CC
"Diagram not to scale
Unit#1
Unit#2 Unit#3 (ti3
o
SW Grady Way
PAGE 5 OF 5