HomeMy WebLinkAbout23-4259 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED52132 170
27
COLLISION REP FIT 1591971
CASE 23-4259 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F E: LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 04 - 16 - 2023 0721 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RENTON AVE S BLOCK NO. e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 20 00 FMILES EET e S ❑ E e HAYES PL SW
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2062714166 0 11
30
6 LAST NAME ARGUETA AVELAR FIRST NAME MOISES MIDDLE 1 2 31
INITIAL
STREET ❑ 12076 RENTON AVE S CITY SEATTLE ST WA ZIP 98178 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'M I ELMIDI Y' 02 — 27 — 1996 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 1HELM
USEET 2 CLASS 1 NATURE OF INJURIES zICEN ❑
3
10 9� P1 ATEB9t BUZ8697 STATE WA vN# 2C3CDXBG5LH151554
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 2 5 VIN#j VIN#
:: FROM TO
VEH.YEAR 2020 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 7 34
13 4 DODG CHARG SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
4 INSURANCE CO 3 4
14 INSURANCE PROGRESSIVE 911490894
IN EFFECT EFFEE CT &POLICY# � 9TOP
vEHla.e
LECALLv Yes❑NO❑ CITATION# 10 BOTTOM
CHARGE 36
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES NO ,/ D:2062966590
16 a
LAST NAME WU FIRST NAME YUZHONG MIDDLE
INITIAL
17❑ NEW STREETREs7 6035 33RD AVE S CITY SEATTLE ST WA ZIP 98118 4❑ 37
18 CDL ., IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YEs❑NOF YES
❑NOF,/
19[ DRIVER'S STATE WA SEX M D.C.B. 08 _ 24 1987 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLATE# 89509C TATE 41
GOV VIN# 1VHHH3V26B6707597 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE ONTR MODEL BUS STYLE B(I VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
L4❑ AMAGE YES NO YES NO
REGISTERED OWNER INFO KING COUNTY DOT TRANSIT 5004TH AVEAVE#653 SEATTLE WA 98104 D:2062966590 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO KING COUNTY METRO KING COUNTY IGQ
5
IN EFFECT
--E ❑ ,J� CITATION# CHARGE
25
LEGALLY YES N`L J
s � a
7JAWEBER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
12532 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52132
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4259
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'
On April 16th, 2023 at approximately 0737 hours I was dispatched to Renton Ave Ext and Rainier Ave
S for a report on a non-injury collision involving a King County Metro bus. I arrived and observed the
damage to both vehicles was below reporting standards, and there were no injuries. There were no
passengers on the bus when the collision occurred. I spoke with Driver 1 who advised he was
traveling eastbound on Renton Ave S when he went to make a right hand turn into the parking lot of
the McDonalds. Driver 1 stated he was in lane 1, and while making the turn he was struck from
behind by Vehicle 2. Driver 2 stated he was on the south shoulder of the road facing eastbound when
Vehicle 1 turned into the parking lot in front of him, and there was not sufficient time or space to stop.
Driver 2 stated there was not enough room for Vehicle 1 to merge in front of him when he did. A KC
Metro supervisor was on scene who completed an information exchange prior to my arrival.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JACOB WEBER 04-16-23 11:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 411712023 5:43:26 PM
BADGE OR ID# 12532 OR]# WA0171300 TIME POLICE DISPATCHED 7:37 AM TIME POLICE ARRIVED';7:38 AM
PART I PAGE IT]OF 4�
SUPPLEMENTAL REPORT NO. ED52132
r`) POLICE TRAFFIC 1 27
COLLISION REPORT CASE# 23-4259
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓ G
UNIT'# 2 USDOT ICC# ' VEHICLE TYPE 1 CARGO 6ODY 1
;TYPE
2 ❑ 1 28
CARRIER KING COUNTY METRO
NAME
3 CARRIER L
ADDRESS 500 4TH AVE#653
CITY SEATTLE ST WA ZIP'', 98104
4 ❑ NAME # PLACARD: :❑
NAME IF NO NUMBER
SOURCE 1 AXLES 02 GI25000 +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO
i MIDDLE'... 29
LAST NAME FIRST NAME INITIAL
STREET 30
NFW AnnRFrtP. CITY ST ZIP
6 2
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31
INTERLOCK YES No zERLOCK YES E]NO� vES N
LLIICIENSE STATE I SEX M��DYRYY' 2
7 F-1
ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES
USE CLASS
8 ❑ ' 1 32
LICENSE+ rar VIN.#
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIG P FROM TO
DAMAGE Y EES NO YES NO
REGISTERED OWNER INFO. m 33
12 SHADE IN DAMAGED AREA
FROM TO
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# tGQ
VEHICLE 34
13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE
STANDING S} 8 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER
YES AGE NOHRESHOLD MET PHONE El
35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE': INITIAL36
STREET"[—]
❑
16 NFln+AnnRFs.� CITY'. ST SIP
CDL IGNITION REQUIRED IGNITtGN PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK 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 ❑ vIN# 39
LICENSE
PLATE# rnr
20 ❑ TRAILER TRAILER ❑ 40
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 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VE EFFECT &POLICY# i 970P - 4 E:l
44
24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
C=DLv
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.
JACOB WEBER 04-16-23 11:38 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26F7 OR ID# 12532 O#I',WA0171300 SCOTT 4/17/2023 PAGE F3 OF
3000-345-013(R 11118)
REPORT NO. ED52132 CASE# 23-4259 DATE AND TIME 04/16/23 07:21
OF COLLISION
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