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Home My WebLink About23-1907 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 23-1907 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 RESERVATION STRUCK z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ dowsloN 02 - 1-- 2023 1454 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ DUVALL AVE NE BLOCK NO. e✓ 400 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 300 00 FEET MILES e S B W e NE 4TH ST 0 4 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:4252277761 2 01 30 6� LAST NAME MORRIS FIRSTNAME WANDA MIDDLE L 9 2 31 INITIAL STREET ❑, 1451 HILLCREST LN NE CITY RENTON ST WA 2jp, 980562318 z 'NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 aT�S� ALM3160 sTArI WAvIN# KNADC125046318191 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR. 3 5 33 12 3 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE $ 34 13 2 2004 KIA RIO DAMAGE vE8 0NO f �AWkkRS vEs❑ No REGISTERED OWNER INFO WANDA MORRIS 1451 HILLCREST LN NE RENTON WA 98056 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 3 4 14 LIABILI INSURANCE INSURANCE CO AARP 55PHT791762 IN EFFECT &POLICY# 9TOP 15❑ vEGAEHA"LE 5 36 LLLY YES�No D CITATION# 3A0179162 CHARGE FAIL YIELD PRIVATE RD MOTOR 1 o sorrow STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067736039 16 a LAST NAME MILLER FIRST NAME MOZEKA MIDDLE M INITIAL 17❑ STREET - 306 6TH AVE S APT 608 CITY' SEATTLE ST WA ZIP 98104 37 NEW ADDRESS ❑ 18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES I'✓ NO❑ 11 19 DRIVER'S STATE FL SEX IF I D.O.B. 07 29 _ 1987 39 LICENSE# MMDDYY H USE ET NJAURSY [NATURE OF INJURIES COMPLAINT OF BACK PAIN ❑ 40 20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 2 7 21❑ LICENSE CFG2267 TAre WA VIN# 5N1AT2MV8LC760432 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2020 MAKE NIS8 MODEL ROGUE STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES�/ NO BANKERS YES NO REGISTERED OWNER INFO MOZEKA MILLER 3066TH AVE S APT 608 SEATTLEWA98104 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO GENERAL INS CO 53-WA-9898991IN IUQ, 5VEHICLe ❑ ,.II CITATION# CHARGELEGALLY YES N25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 K.LANE 10008 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. ED35842 COLLISION REPORT III III III III III 111 1591972 CASE# 23-1907 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST FIRST,MIDDLE INITIAL)_ ADDRESS&PHONE# SEX D.O.B. - - MMDDYYYY. PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D D B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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' Unit 1 was stopped facing westbound on the east side of Duvall AVE NE in the 400 blk coming out of the Bartell Drugs parking lot intending to turn left onto southbound Duvall AVE NE. Unit 2 was traveling southbound in the 400 bk of Duvall AVE NE in the right lane approaching Unit 1 and traveling with the right of way. Unit 3 was also traveling southbound in the 400 blk of Duvall AVE NE in the left lane and in front of Unit 2 but at a slower speed. Driver 1 states that she thought she checked the traffic and began to pull out to make her left turn onto southbound Duvall AVE NE. Unit 1 appeared to be trying to enter the right lane (that was occupied by Unit 2) and when Unit 1 pulled out to make the left turn, it pulled into the path of Unit 2. The front passenger corner of Unit 1 struck the front driver's side corner of Unit 2. The force of this collision sent Unit 1 rotating counterclockwise and the front end of Unit 1 struck the rear passenger wheel of Unit 3. Unit 1 sustained moderate/heavy front end damage. Unit 2 sustained disabling but moderate damage to the front driver's wheel area. Unit 3 sustained minor damage to the rear passenger wheel. Driver 2 complained of back pain and was transported to VMC for evaluation. Unit 1 and 2 towed by Bankers tow. Driver 1 was cited for failure to yield the right of way to a motor vehicle when entering from a private roadway by, while trying to exit a private parking lot, failing to yield the right of way to Unit 2 which was the proximate cause of the collision. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. K.LANE 02-16-23 04:14 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT CO.JOHNSON 0505 212112023 10:20:09 AM BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED Y:87 Pry TIME POLICE ARRIVED',3:00 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. ED35842 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-1907 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:4259417093 0 1 Zg LAST NAME : BARUAH FIRST NAME ARATI MIDDLE'.. B INITIAL STREET 30 NEW AnDRFSP 14420 1521VD PL SE CITY RENTON ST WA ZIP 1 980597340 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs No NTERLOCK YES[:]NO[:] YEs N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 03 - 24 - 1950 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE AUW3658 TAr WA VIN# JHLRE48518CO36003 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2008 MAKE HOND MODELCR-V STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH11' P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFOPRANAB BARUAH 14420152ND PL SE RENTONWA 98059 1 5 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE INSURANCE CO FARMERS 200040134 q"i"Olx IN EFFECT I POLICY# 1 EwcLE 34 13 ❑ LEGALLY YES❑ NO❑ CITATION# CHARGE 0 BOTTUM STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEOESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STRE 16 NEW ETET".Fl CITY ST ZIP AnnRCDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT 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 a 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE 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. K.LANE 02-16-23 04:14 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 10008 O#IL WA0171300 JOHNSON 2121/2023 PAGE 3 OF 4 3000-345-013 IR 11t18) REPORT NO. ED35842 CASE# ' 23-1907 DATE AND TIME 02/16/23 14:54 OF COLLISION V} � LLJ r � r R a cs C r- r � r C� 7 A m J J W —NOT TO SCALE""" rr PAGE 4 OF 4