HomeMy WebLinkAbout22-13480 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 22-13480 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 4 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 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 1126 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e 154TH PL SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4253065943 1 01
30
6� LAST NAME BECKHAM FIRSTNAME JIAYI MIDDLE J 1 2 31
INITIAL
STREET ❑ 26318 203RD PL SE CITY COVINGTON ST WA ZIP, 980425062 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� 8M24918 sTArI CA urN# 1 GCCS33E188222091
TRAILER STATE TRAILER STATE
11 5 0 PLATE# PLATE# ROM ro
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 1 3 34
13 2 2008 CHEV IMPALA DAMAGE YES NO �MEYER YES : NO✓
REGISTERED OWNER INFO ENTERPRISELESING 11100 BEECHAVE FONTANA CA 90749 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICV# 9TOP
VE— CHARGE 10BOTTOM 5 36
LEGALLY YEs❑NO CITATION# 2A0276937,2A0276937 SPEED TOO FAST FOR CONDITIONS,
15❑ STANDING 7 6
UNIT 02 VEHICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERRTY ❑ DYES NO OLD MET PHONE
16 a
LAST NAME HELLAND FIRST NAME JEFFREY MIDDLE A
INITIAL
17❑ STREET ❑', 21110 SE 200TH ST CITY' RENTON ST WA ZIP 980580237 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LDI IVER # STATE WA SEX M M .C... 11 � 1959 22 _ El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C51715Y TAre WA vIN# 4F4YR12D56PM03025
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2006 MAKE MAZp MODEL B2300 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO UNKNOWN YES NO
REGISTERED OWNER INFO JEFFREY HELLAND 21110 SE 200TH ST RENTON WA 980580237 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO GEIC04114-80-28-14IN 9TOP 5
VE""LE ❑ N,J� CITATION# CHARGE
LEG i o BOTTOM
ALLY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED19080
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13480
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MILLER LOGAN
(LAST FIRST,
ADDRESS&PHONE#
2533896138 SEX i U MMDOYyry 05 - 26 - 1984
---------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
'(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT I 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 12-20-22 12:45 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1
1212712022 12:58:52 PM
BADGE OR ID# Y517 ORI# WA0171300 TIME POLICE DISPATCHED 49:27 AM TIME POLICE ARRIVED 11:36 AM
PART I PAGE 2�OF❑
REPORT NO. ED19080 CASE# 22-13480 OF COLLISION
12/20/22 11:26
OF CbLLI510N
NARRATIVE
gray/unit 1 mvh slides thru red hit wht/unit 2 pu and then hits unit 3 slv suv while attempting left from
154th
CC
Within the city limits of Renton/King/WA I responded to a 3 car blocking crash at the intersection of
Maple Valley Hwy at 154th PI SE.
I contacted the driver of unit 3 who told me he was making a left turn from 154th to MVH when he saw
unit 1 sliding through her red light and crash into the truck in front of him. After unit 1 hit unit 2 he said
unit one then hit him. He did not complain of injury but damages required a tow truck.
I contacted the driver of unit 2 who told me he was proceeding on his green light to turn left from
154th onto MVH when unit 1 going too fast for the snow/slush conditions slid through the her red light
and crashed into the side of his truck. He did not complain of injury and damages required a tow
truck. He refused a rtto tow and used his own.
I contacted the driver of unit 1 ID'd by her picture WADL. She told me she was trying to stop but her
tires just kept rollings. I asked if she meant skidding/sliding and she didnt answer. She said her light
was red and she could not stop and did not provide additional information. She did not provide any
form of insurance for her rental car.
I cited unit 1 via complaint ref RCW 45.61.400 Speeds too fast for conditions and ref RCW 46.30.020
No Insurance.
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 12/20/2022
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. ED19080
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 22-13480
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
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:4253069065
0 29
LAST NAME : WONG FIRST NAME TI MIDDLE 1
INITIAL
STREET 30
NEW AnDRFSP' 4916 SE 2ND PL CITY RENTON ST WA ZIP 98059
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:]
YEs N
DRIVER'S
LICENSE STATE I WA SEX U MMDDYYv 04 - 04 - 1960
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BVS1018 [TAT WA VIN# 2T3RWRFVXLW098273
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 3 5 VEH.YEAR2020 MAKE TOYT I MODELRAV4 STYLE VEHICLE TOWE ET SABLI W,6'•ER GnVT VFI.1C F FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO.TI VUONG 4916 SE 2ND PL RENTON WA 98059 1 3 33
12
SHADE IN DAMAGED AREA
7 j FROM TO
INSURANCE CO
LIABILITY INSURANCE SAME. 1i"01 m 34
IN EFFECT &POLICY#
13 ❑ VEHICLE ❑ ❑ CITATION# CHARGE 0 BOTTOM
VEHICLEGALLY YES NO
STANDING S} 7
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE
❑ 36
ET
16 STRETRENEW "F ' CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YEs NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR.I EJECT I HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ 39
LICENSE rnr vIN#
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ TRLR TRLR 41
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 '
VE EFFECT &POLICY# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
C=DLv
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.
X LEVERTON 12-20-22 12:45 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED
226 � BADGE O#I'WA0171300 N 12 PAGE OF
3000-345-013(R 11118)
REPORT NO.! ED19080 CASE# ' 22-13480 DATE AND TIME 12/20/22 11:26
OF COLLISION
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PAGE 5 OF 5