HomeMy WebLinkAbout23-1714 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. ED33343 170
27
COLLISION REP FIT 1591971
CASE 23-1714 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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# ❑
cowsloN 02 - 10 - 2023 1535 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BRONSON WAY N BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S ❑ W e SUNSET BL N
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:7722307470 N:4257612256 0 11
30
6� LAST NAME SHINE FIRSTNAME ANNETTE MIDDLE R 1 1 2 31
INITIAL
STREET El 4321 S WARSAW ST CITY SEATTLE ST WA 2jp, 98118 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED1/ I IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO NTERLOCKYEs Z/NO YEs �No /
LRIIVER # STATE WA SEX'F MM D Y' 06 - 17 -
8❑ 1981 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET 2 CLASS 0 NATURE OF INJURIES 2❑
3
10[9 EN
p7 ATE BYS2996 STATE WA VIN# KNDJP3A53E7080890
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. TRLR. 3 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 3 34
13 4 2014 KIA SOUL UT DAMAGE YES NO YES
❑ NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LEGALLY YEs No CITATION# 3A0223570 OP MOT VEH W/OUT INSURANCE o Borro6
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4255189088
16 a
LAST NAME WHEELER FIRST NAME SERENA MIDDLE L
INITIAL
17❑ NEW STREETR 7 11639 SE 217TH PL CITY KENT ST WA ZIP 98031 37
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[—] LDI IVERS STATE WA SEX F M .C... 11 25 _ 1987 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CAX5865 TATE 41
WA VIN# 5XYPKDA51KG448450 4
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE KIA MODEL SORREN STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SERENA WHEELER 11639 SE 217TH PL KENT WA 98031 D:4255189088 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE I PORGY#ECO STAE FARM 4884523C2547BIN 1GQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
7TRADER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 4553 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED33343
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1714
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WHEELER ROMEO J
(LAST FIRST,
ADDRESS&PHONE#
11639 SE 217TH PL TUKWfLA WA 98031 4255189088 SEX M MMDovyvv 04 - 29 - 2021
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 2 POS. 4 2 11 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) SKOGLUND GRACE C
ADDRESS&PHONE# D O B
13326 MILITARY RD S TUKWILA WA 98168 2063554717 SEX F MMODvyvv 01 _ 10 _ 2017
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 3 POS 6 AIRBAG 2 RESTR. 10 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
J.TRADER 02-12-23 07:44 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 211212023 10:31:42 PM
BADGE OR ID# 4553 ORI# WA0171300 TIME POLICE DISPATCHED 4:20 PM TIME POLICE ARRIVED',4:25 PM
PART I PAGE IT]OF
REPORT NO. ED33343 CASE# 23-1714 OF COLLISION
02/10/23 15:35
OF CbLLI510N
NARRATIVE
On 02/10/2023 at approximatley 1620 hours, I was dispatched to a three car non injury collision in the
area of N 3rd ST and Sunset BL N.
Upon arrival I wpoke with the driver of Unit 3 who was identified by a WA State driver license as KART
SKOGLAND. SKOGLAND was driving vehicle license BOV5224 on Bronson Way N at Sunset BL N.
SKOGLAND was stopped for traffic in the number three lane of Bronson Way N just West of Sunset
BL N. SKOGLAND said Unit 1 license BYS2996 was behind her and then Unit 1 attempted to go
around SKOGLAND striking Unit 2 then bounced off and struck SKOGLAND'S vehicle.
I spoke with the driver of Unit 2 who was identified as SERENA WHEELER and her vehicle license
was CAX5865. WHEELER confirmed she was driving her vehicle on Bronson Way N just west of
Sunset BL N in the number two lane. WHEELER wasn't sure where Unit 1 came from but Unit 1
crashed into her vehicle and then bounced off and hit Unit 3.
1 asked the driver of Unit 2 and Unit 3 where Unit 1 and the driver went. They both confirmed she left
the scene after allowing them to take a picture of her WA State license. The driver of Unit 1 was
identified as ANNETTE SHINE. SHINE also provided WHEELER and SKOGLAND two conact phone
numbers. SKOGLAND and WHEELER both confirmed Unit 1 was at fault for striking both vehicles
who were legally occupying their respective lane of travel.
I spoke with SHINE via phone and she didn't believe she was at fault for the collision. I told SHINE
she was responsible for making a safe lane change and to make sure the lane she is attempting to
move into isn't already occupied. SHINE did not have insurance for her vehicle.
I issued a warning for making an Unsafe Lane Change and issued a citaiton for Operating a Motor
Vehicle without Liability Insurance. I informed SHINE she would recieved the citations in the mail and
confirmed her home address was correct with DOL.
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. ED33343
r`I POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-1714
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST' ZIP'
4 ❑ NAME # PLACARD: :❑
GI NAME 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:2063554717
OF 7 29
LAST NAME SKOGLAND FIRST NAME : KAR/ MIDDLE A
INr:j
ITIAL
STREET 30
NEW AnDRFSP' 13326 MILITARY RD S CITY TUKWILA ST WA ZIP 98168
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs NO zERLOCK YES❑N0� YEs N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv 10 - 08 - 1980
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BOV5224 [TAT WA VIN# 2GNAXSEV5K6305527
PLATE#
9 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 P FROM TO
2019 CHEV EQUINOX UT DAMAGE YES NO YES NO
REGISTERED OWNER INFOKARI SKOGLAND 13326 MILITARYRD S TUKWILA WA98168 D:2063554717 J 9 33
12 � SHADE IN DAMAGED AREA
34 FROM TO
LIABILITY INSURANCE INSURANCE CO SAFECO H2391376 GQ
IN EFFECT &POLICY# 1EHICLE 34
13LEGALLY YES NO❑ CITATION# CHARGE
STANDING S} 8 7
14 ❑ UNIT Tr Vd 1RE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
❑
36
15 LAST NAME FIRST NAME ': NIbIAL
STREET
16Fl NEW STRE "Fj' CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YES NO ❑
17 6 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE TAT VIN# 39
PLATE#
20 ❑ TRAILER TRAILER El40
PLATE#< STATE PLATE# STATE
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 3 4 4 AREA F 43
z
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.
J,TRADER 02-12-23 07:44 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY I DATE
26 OR ID# 4553 O#I',WA0171300 CHRISTIANSEN 2112/2023 PAGE�OF
3000-345-013(R 11118)
REPORT NO. ED33343 CASE# ' 23-1714 DATE AND TIME 02/10/23 15:35
OF COLLISION
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ewaaso�a vaav r:
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PAGE 5 OF 5