HomeMy WebLinkAbout23-2563 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-2563 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 03 - 1-- 2023 1413 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S GRADY WAY BLOCK NO. e✓ 700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ MILE N❑ FEET e S ❑ E e TALBOT ROAD SOUTH
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252757413 0 9 30
6� LAST NAME SMITH FIRSTNAME CINCINATI MIDDLE 1 1 2 31
INITIAL
STREET ❑ 14037 SE 192ND ST CITY RENTON ST WA ZIP' 980589408 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ Pi aT�S� C60484R sTATe WAurN# 1C6RR7TT4KS643056
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 5 33
12 3 5 VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE g 9 34
13 4 2019 RAM 1500 PK DAMAGE YES NO YES❑ ✓No
REGISTERED OWNER INFO HONEYWELL INTERNATIONAL INC 16915 NE 28THWAY VANCOUVER WA 98682 D:3603385780 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GREENWICH INSURANCE CO.RAC943764208 3 4
IN EFFECT &POLICY# 9TOP
vEHICLE 5 36
E�ALLr re5 No CITATION# 3A0055504 CHARGE INATTENTIVE DRIVING o eorrom
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7706244222
16 a
LAST NAME STUTHERS FIRST NAME MICHELLE MIDDLE
INITIAL
17❑ NEW ADDRE— 16890 1STREET 64TH WAY SE CITY' RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NoF,/
19 DRIVER'S STATE WA SEX F D.C... O6 _ 04 1992 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES ❑ 40
USE CLASS C/O
ILICENSE ❑
21❑ PLA E# BRG7888 TATE WA VIN# USE
LOWER BACK PAIN 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE TOYT MODEL COROLL STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO MICHELLE GALVIS 16890164TH WAY SE RENTON WA 98058 D:7706244222 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#ECO GEIC04577929781IN 1GD
vE""LE CITATION# CHARGE
LEGALLY YES N(�
25❑ s a
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 11498 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED40388
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2563
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
PM 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'
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 03-02-23 04:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 31712023 3:26:21 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 2:97 Pry TIME POLICE ARRIVED',2:25 PM
PART I PAGE IT]OF 4�
REPORT NO. ED40388 CASE# 23-2563 OF COLLISION
03/02/23 14:13
OF CbLLI510N
NARRATIVE
23-2563
On 03/02/2023 at approximately 1417 hours, I was dispatched to a non-injury and non-blocking
vehicle collision at the intersection of South Grady Way and Talbot Road South, within the City Limits
of Renton, County of King, State of Washington.
Upon arrival, I confirmed there were no complaints of injury from either of the involved parties
requiring immediate medical response at the time of report. The driver of Unit#2 did complain of
lower back pain but declined Renton Fire/Ambulance response. 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 he was the sole occupant of his company vehicle and was traveling
eastbound in about the 700 block of S Grady Way in lane 1 of 4 and was intending to turn right to
proceed southbound onto Talbot Rd S. The driver of Unit#1 stated he was traveling directly behind
Unit#2 and said that Unit#2 abruptly stopped in front of his work vehicle. The driver of Unit#1 stated
that as a result, Unit#1 subsequently collided with the rear of Unit#2 causing moderate damage to
the front of Unit#1.
The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling eastbound
in about the 700 block of S Grady Way in lane 1 of 4 and was intending to turn right to proceed
southbound onto Talbot Rd S. The driver of Unit#2 stated that while stopped and preparing to make
the right turn, Unit#1 collided with the rear of Unit#2 causing minor damage to the rear bumper of
Unit#2. The driver of Unit#2 believed that Unit#1 was following too close.
Based on the above statements, I determined that the Driver of Unit#1 (Smith) was the predominant
factor for the cause of collision due to following too closely causing a collision.
I cited Smith by mail for Following Too Close causing a collision.
Both Unit#1 and Unit#2 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 4:30 PM 3/2/2023 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED40388 CASE# ' 23-2563 DATE AND TIME 03/02/23 14:13
OF COLLISION
Diagram not to scale
e
S Grady Way
v
07
Unit#1 O
�T
Unit:#2 /u
O
v
12
PAGE 4 OF 4