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Home My WebLink About23-0094 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 23-0094 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI 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 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cawsloN 01 - 1-- 2023 0723 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. e✓ --- ----� ❑ TALBOT RD S MILEPOST 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e S 48TH ST 0 1 29 MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 7 30 6� LAST NAME NELSON FIRSTNAME AMMON MIDDLE J 1 1 2 31 INITIAL STREET ❑1 26808 171 ST PL SE APT C102 CITY COVINGTON ST WA ZIP 980424995 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 3 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 ATE 14 C31644M STATE WA uN# NMOLS7F70H1324069 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TREK. YRLR. 5 1 33 12 0 0 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE J 9 34 13 2 2017 FORD TRANSI DAMAGE YES NO MEYER YES[:] NO✓ REGISTERED OWNER INFO HAINS.Tl CO LAUNDRY 1911 E SPRINGFIELD AVE SPOKANE WA 99202 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 ABILI V INSURANCE INSURANCE CO OLD REPUBLIC L583960.19 3 4 IN EFFECT &POLICY# 9TOP VEHCLE CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# INATTENTIVE DRIVING 1 o eorrom 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES�/ NO D:4253065078 16 a LAST NAME VO FIRST NAME MYLE MIDDLE T INITIAL 17❑ STREET ❑', 10320 SE 186TH ST CITY' RENTON ST WA ZIP 980558429 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 DRIVER'S STATE WA ]SEX IF D.Q.B. 08 _ 11 1972 0 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE 981YKN TATE I WA VIN# JTEES41A382104248 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE El 23❑ 43 TRLR RLR VIN#. IN#. YEAR 2008 MAKE TOYT MODEL HIGHLAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 VEH 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO LOC LAM 10320 SE 186TH ST RENTON WA 98055 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE &POLICY#E CO SAME.IN 9TOP 'E""LE CITATION# CHARGE LEGAL 25 i o BOTTOM LY YES Nu ❑ s 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. ED21821 COLLISION REPORT III III III III III 111 1591972 CASE# 23-0094 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) LAM RYAN H (LAST FIRST, ADDRESS&PHONE# D O.B. 10320 SE 186TH ST RENTON WA 980558429 SEX M MMDOYyry 06 - 03 - 2013 {� SEAT HELMET INJURY NATURE OF INJURIES PASSENGER Z WITNESS❑!UNIT# 2 Pos. 7 AIRBAG 2 RESTR. 4 EJECT USE CLASS 7 NECK NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB E 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.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. M.LEVERTON 01-03-23 08:12 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE S.MORRIS 2613 1/4/2023 11:42:08 AM BADGE OR ID# 2517 ORI#' WA0171300 TIME POLICE DISPATCHED! 7:25 AM TIME POLICE ARRIVED:7:31 AM PART I PAGE IT]OF 5� REPORT NO. ED21821 CASE# 23-0094 OF COLLISION 01/03/23 07:23 OF CbLLI510N NARRATIVE wht mini van rear slv suv stop hit maroon suv stop CC Within the city limits of Renton/King/WA I responded to a 3 car blocking crash at Talbot Rd S and S 48th St. I located 3 car blocking northbound Talbot Rd S. I contacted the driver of unit 3 who told me he was stopped for traffic when unit 1 hit unit 2 pushing 2 into him. He did not complain of injury and damages did not require a tow truck. I contacted the driver of unit 2 who was holding the head of her young son. She told me she was hit and her son was complaining of a sore neck. Renton Fire arrived, treated and released unit 2 passenger on scene. Unit 2 driver did not complain of injury and damages did not require a tow truck. I contacted the driver of unit 1 ID'd by his picture WADL. He told he was not paying attention and caused the crash, driving into the back of unit 2 pushing 2 into unit 3. He did not complain of injury and damages did require a tow truck (Gene Meyer). I cited Unit 1 driver Ref RMC 10-12-25 Driver Inattention 3 car injury crash via complaint. 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 01-03-2023 PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED21821 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-oo94 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 DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ 0 7 29 LAST NAME KUMAR FIRST NAME ASVEEN MIDDLE' ',, IN STREET 30 NEW AnDRFSP' 15814 SE FA{RWOOD BLVD CITY RENTON ST WA ZIP 980588632 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 M MMDDYYv 08 - 14 - 1979 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE I CDV8298 [TAT WA VIN# JTEAAAAH2MJ085530 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2021 MAKE TOYT I MODEL VENZA STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1G P FROM TO DAMAGE YES NO ✓ YES NO ✓ 33 REGISTERED OWNER INFOASHILTA KUMAR 15814 SE FAIRWOOD BLVD RENTONWA 98058 J 9 SHADE IN DAMAGED AREA 12 7 j 4 FROM TO INSURANCE CO LIABILITY INSURANCE SAME. 34 IN EFFECT &POLICY#13VEHICLE ❑ CITATION# CHARGE GQO LEGALLY YES NO STANDING S} 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNER YE YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ ET 16 STRETRE "F ' CITY ST ZIP NEW CDL 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 VIN# PLATE# rnr 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 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 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LERICLE 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. X LEVERTON 01-03-23 08:12 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OI BADGE 2517 O#I',WA0171300 APMORRIS 1/44/2023 PAGE F OF 5 3000-345-013(R 11118) REPORT NO. ED21821 CASE# ' 23-0094 DATE AND TIME 01/03/23 07:23 OF COLLISION AW INK Arl nt ��..4• ..�V:Y YY YY...Y..Y.Y.Y.Yr YYY i....Y.d¢.vp �,� ��,�,�.. ��, #t 3 nit nit 1 PAGE 5 OF 5