HomeMy WebLinkAbout23-3694 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-3694 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4'I00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DArE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 04 - 01 - 2023 1805 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 13100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
6❑ 200 00 FEET e S ❑ W e 131STAVESE
0 1 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD PHONE 0 11
30
6� LAST NAME DUDLEY FIRSTNAME MONRAE MIDDLE R 1 2 31
INITIAL
STREET El 125 SW CAMPUS DR 10-206 CITY FEDERAL WAY ST WA ZIP, 98023 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICENSE WA STATE Wq SEX'F MM DAY' 01 - 16 - 1998 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H USE ET 2 CLASS'NJURY7 [NATURE OF KNEE PAIN JURIES z❑
3
10� Pi aT�S� BZ3112 srAT1 WAurN# 1G1PC5SG3G7172899
TRAILER STATE TRAILER STATE
11 4 5 PLATE# I PLATE# I I FROM TO
TRLR. TRLR 7 3 33
12 4 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TAW/[g GOVT.VEHICLE 34
13 4 2016 CHEV CRUZE P4 D AMA G 7 3 E YES NO TOWING YES❑ No✓
REGISTERED OWNER INFO MONRAE DUDLEY 121 SWCAMPUS DR 10-206 FEDERAL WAY WA 98023 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 4
14 PROGRESSIVE 921387657
IN EFFECT I POLICY# TOPVEr�ICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�NiT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:4259965951
16 a
LAST NAME WEBSTER FIRST NAME SIWARUK MIDDLE
INITIAL
17 STREET❑ NEW ADDRESS❑' 27318 SE 230TH ST CITY MAPLE VALLEY ST WA ZIP 98038 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 LICENSE# STATE WA ]SEX IF M D.O.B. 02 _ 20 _ 1971 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLATE# 214XKI TATE 41
WA VIN1 1J4GW68S3XC554321 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 1999 MAKE JEEP MODEL GRAND STYLE p4 VEHICLE TOWED TO BLIN TOWEDeY GOV HI �44
24 DAMAGE YES NO BANKERS TOWING YES NO%/
REGISTERED OWNER INFO BRADLEY WEBSTER 27318 SE 230TH ST MAPLE VALLEY WA 98038 D:4259965951 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE❑ &POINSURGY#E CO GEIC04467-37-91-39IN 9TOP
IETCLe YES❑ N J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
D.NELSON 12421 WA0171300
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED47554
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3694
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LAISENI MESAKE
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
13318 SE 176TH LN RENTON WA 98058 2067750242 SEX M MMDDYyry 03 - 15 - 1988
PASSENGER WITNESS UNIT# SEAT AIRBAG i RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ �' POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
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.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 4/1/2023 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a two vehicle collision with injury in the 13000 block of
Maple Valley Highway. An on-duty KCSO Deputy had on-viewed a collision and was currently out
with both vehicles.
I arrived on scene and located a red 1999 Jeep Grand Cherokee (WA/214XK1) driven by Siwaruk
Webster (DOB: 2/20/1971). The Jeep was stopped facing eastbound on the #2 lane of Maple Valley
Highway. It had slight damage to the rear bumper. KCSO Deputy Nelson advised that he spoke to the
driver who advised she was stopped waiting on traffic when she was struck by the second vehicle.
Siwaruk was not injured and the Jeep was removed from the scene by Bankers Towing.
The second vehicle, a gray 2016 Chevrolet Cruz (WA/BZE3112), driven by Monae R Dudley (DOB:
1/16/1998) was up on the curb also in the #2 lane. There was damage to the front bumper of that
vehicle. The driver was evaluated by RRFA personnel and cleared at the scene. Deputy Nelson
advised that a witness advised that Monrae was driving behind and struck the Jeep from behind. This
vehicle was also removed from the scene by Bankers Towing.
Both parties were provided with an Exchange of Information.
I then cleared the scene.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.NELSON 04-01-23 07:16 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 4/1/2023 9:09:27 PM
BADGE OR ID# ! 12421 ORI#' WA0171300 TIME POLICE DISPATCHED 8:07 PM TIME POLICE ARRIVED',6:12 PM
PART I PAGE IT]OF 3�
REPORT NO. ED47554 CASE# 23-3694 DATE AND TIME 04/01/2318:05
OF COLLISION
13000_block of Maple Valley Highway
t
�"'� �Jeep Grand Cherokee
Chevrolet Druz
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