HomeMy WebLinkAbout23-4035 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-4035 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4'!00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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# ❑
COLLISION.. 04 - 10 - 2023 1304 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH STREET BLOCK NO. e✓ 3901
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 476 00 FMILES N EET e S B E e UNION AVE NE
1 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2065793179 30
6� LAST NAME KLEEMANN FIRSTNAME MICHAEL MIDDLE E 1 2 31
INITIAL
STREET ❑ 13708 SE 201 ST ST CITY KENT ST WA ZIP 980423037 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CEK9234 sTAr1 WAvIN# KNDJT2A67D7570133
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 0 33
12❑ VIN#' VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE g 9 34
13❑9 2013 KIA SOUL UT DAMAGE YES NO YES[:] ✓No
REGISTERED OWNER INFO MlCHAELKLEEMA111804SW308THPLAPTD FEDERAL WAY WA 98023 D:2065793179 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 536378OD-08.47 3 4
IN EFFECT &POLICY# 9TOP
vEHICE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
�IJNIT VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES�/ NO D:2533370631 N:2533370631
16 a
LAST NAME ' SMITH FIRST NAME KAREN MIDDLE M
INITIAL
17❑ NEW ADDRE— 1414 MOSTREET NROE AVE NE#330 CITY RENTON ST WA Zip 98056 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NO❑
19 LDI IVER # STATE WA SEX F M D.O.B. 04 02 _ 1946 39
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT , HELMET 2 INJURY 6 NATURE of INJURIES 40
USE CLASS C/O RIGHT KNEE PAIN
❑21❑ LICENSE TArE IN# 41
V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24 1 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED50930
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4035
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SEPULVEDA CHASON A
(LAST FIRST,
ADDRESS&PHONE#
21836 242ND PL SE MAPLE VALLEY WA 98038 2533170063 SEX M MMDOYyry 08 - 26 - 2005
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) RODRIGUEZ LAISHA M
ADDRESS&PHONE# D O B.
12440 AMBAUM BLVD SW BURIEN WA 98146 2069811759 SEX' F MMDDYVYv 02 _ 06 _ 2004
PASSENGER WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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 04-10-23 06:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 4/13/2023 11:44:16 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED; 4:07 PM TIME POLICE ARRIVED',4:09 Pm
PART I PAGE IT]OF 4�
REPORT NO. ED50930 CASE# 23-4035 OF COLLISION
04/10/23 13:04
OF CbLLI510N
NARRATIVE
23-4035
On 04/10/2023 at approximately 1307 hours, I was dispatched to a motor vehicle versus pedestrian
injury collision at UW Medicine, located at 3901 NE 4th Street#103, within the City Limits of Renton,
County of King, State of Washington.
While en route, Dispatch advised that the pedestrian had gotten up after being helped by UW staff but
was complaining of injury. Dispatch also advised that Renton Fire had simultaneously been
dispatched.
Upon arrival, I contacted the pedestrian, later identified by WADL photo as Smith. Smith was
complaining of right leg and knee pain due to contact from Unit#1. 1 also contacted the driver of the
only involved vehicle who was uninjured.
The driver of Unit#1 was positively identified via pictured WADL as Kleemann. The driver of Unit#1
stated he was the sole occupant of his vehicle and was leaving an appointment (UW Medicine) and
began reversing out of a parking stall in the parking lot, near the SE corner of the lot. The driver of
Unit#1 stated that while reversing, his foot repeatedly slipped off the brake pedal and that he could
not bring his vehicle to an immediate stop. The driver of Unit#1 stated that his vehicle had struck a
pedestrian but that he did not believe the pedestrian was on the sidewalk. The driver of Unit#1 had
obtained control of his vehicle and moved forward, parking the vehicle into a parking stall. The driver
of Unit#1 said that the collision was accidental, and the driver of Unit#1 was cooperative at the
scene with Police investigation.
Smith confirmed that she was on the sidewalk and just outside the main pedestrian entrance to UW
Medicine. Smith stated that she had just completed an appointment and was waiting for her access
bus to pick her up. Smith uses a walker for assistance and was seated on the walker when she
observed Unit#1 begin reversing. Smith stated that Unit#1 reversed and "never stopped". Smith
stated that Unit#1 came up and onto the curbed sidewalk before contacting Smith and pinning her
against the UW building. Smith said she experienced leg and knee pain. I observed Renton Fire later
treat Smith at the scene and release her.
Two independent witnesses, verbally identified as Chason Sepulveda and Laisha Rodriguez, stated
that they both observed Unit#1 drive up and onto the curbed sidewalk in reverse, subsequently
contacting the pedestrian (Smith) who was just sitting there and waiting.
Both involved parties were provided a copy of the exchange of information. Unit#1 departed without
incident. Unit#2 remained waiting for her Access bus.
Based on the above statements, 1 determined the driver of Unit#1 was the predominant factor for the
cause of collision based on his inability to assume control of a moving vehicle. The collision occurred
on private property and therefore the driver of Unit#1 was not cited.
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 4/10/2023 5:46 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED50930 CASE# ' 23-4035 DATE AND TIME 04/10/23 13:04
OF COLLISION
:Unq ff2
'Diagram nog to scale
IUN Medbcttn 3961 NE 4lh Street;.Renton
PAGE 4 OF 4