HomeMy WebLinkAbout23-4366 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-4366 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OS STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
COLLISION.. 04 - 18 - 2023 1544 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N BLOCK NO. e✓ 500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 6TH ST
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:4259237259 0 7 30
6� LAST NAME VERGE FIRSTNAME ZACHARY MIDDLE G 1 1 2 31
INITIAL
STREET ❑ 18306 34TH AVE SE CITY BOTHELL ST WA ZIP 980128353 z
'NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C73471 P sTArI WAurN# 1 FTNW21 F8YEC86066
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2000 FORD F250 PK DAMAGE YESNo YYES[:] NO
❑
REGISTERED OWNER INFO ZA.RYVERGE 18814A IRIS CT ARLINGTON WA 98223 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 928638842 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES No CITATION# 3AO346426 FOLLOW VEHICLE TOO CLOSELY o eorrom
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2066175999
16 a
LAST NAME MILLER FIRST NAME LINDSAY MIDDLE R
INITIAL
17 STREET I❑ 6232 35TH AVE NE UNIT B CITY' SEATTLE ST WA ZIP 981157315 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NoF,/
19 LDIIVER # STATE WA ]SEX IF M .C.B. 09 _ 28 _ 1981 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# APK1217 TArE WA VIN# 41
JHMGD38677S068113 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2007 MAKE HOND MODEL FIT STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO DUANE RAMSEY 25003 N PERRY RD COLBERT WA 99005 VEHICLE NO.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 912642860IN STOP
VEHICLE CITATION# CHARGE
25❑ to BOTTOM
LEGALLY YES N�
J 7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MIN FLICK 12825 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52569
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4366
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'
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.
BENJAMIN FLICK 04-18-23 06:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 4/19/2023 6:12:56 AM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED! 3:46 PM TIME POLICE ARRIVED 3:46 PM
PART I PAGE IT]OF
REPORT NO. ED52569 CASE# 23-4366 OF COLLISION
04/18/23 15:44
OF CbLLI510N
NARRATIVE
23-4366
On 3-17-23 at approximately 1203 hours I was working as a Renton Police Officer for the Renton
Police Department on patrol in full uniform in the city of Renton, King County, Washington. I
responded to a motor vehicle collision at the cross of N 6th ST and Logan AVE N.
Upon arrival I made contact with all three vehicles involved. All three involved drivers agreed upon
the circumstances that occurred which were as follows:
All 3 involved units were northbound on Logan AVE N, approaching the traffic light on N 6th ST.
Unit 3 (WA/BWS5721) driven by driver Mary L. Price (DOB: 03-18-1955 via WADOL) braked when
the light at the cross of Logan AVE N and N 6th ST turned yellow and she knew she was not going to
make the light. She braked and stopped at the intersection. Unit 2 (WA/APK1217) driven by Lindsey
R. Miller (DOB: 09-28-1981 via WADOL) was behind unit 3, braked and was able to stop short of
colliding with unit 3. Unit 1 (WA/C73471 P) driven by driver Zachary G. Verge (DOB: 05-27-1997 via
WADOL) was behind unit 2, braked, but was not able to get his vehicle stopped in time. His vehicle
collided with unit 2, which pushed unit 2 into unit 3.
Driver Verge said that he braked, his brakes "locked up" and he steered to the left to attempt to avoid
the collision, but still collided with unit 2.
Driver Miller said that when she saw Verge braking, he was pretty far away and she thought he was
going to be able to stop.
Driver Price mentioned that she had lower back pain as a result of the collision. She was examined
on scene by Renton Regional Fire Authority.
I provided all three parties with an exchange of information via Sector which contained the case
number.
I observed that the damage to the vehicles was consistent with what all 3 parties had told me.
At the conclusion of my investigation, I determined that driver Verge had been following too closely as
he was not able to stop in time. I confirmed with driver Verge that his DOL address was current. I
informed driver Verge that he would be receiving a citation for following too closely via mail.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 04-18-23 in Renton, WA.
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. ED52569
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-4366
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST ZIP—1 I '
4 ❑ NAME # PLACARD: :❑
GI PLACARD IF NO NUMBER
SOURCE AXLES +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER � YES NO
D:2066978324
0 8 29
LAST NAME PRICE FIRST NAME MARY MIDDLE'.. L
INITIAL
STREET 30
NEW AnDRFrtP 2361 31 ST AVE S CITY SEATTLE ST WA ZIP 981445523
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TAN5PORTE6
INTERLOCK YEs NO NTERLOCK YES❑N0� YEs N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv 03 - 18 - 1955
7
HELMET :INJURY' NATURE OF INJURIES
ON DUTY STATUS AIRBAG'' 2 RESTR. 4 EJECT 1 USE 2 CLASS 7 BACK PAIN
8 ❑ 1 32
LICENSE BWS5721 TAr WA VIN# JN8AS5MT6FW673532
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 3 5 VEH.YEAR2015 MAKE NISS MODELROGUE I STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vEH1I' E FROM TO
DAMAGE YES 'E YES NO
REGISTERED OWNER INFOMARY PRICE 236131ST AVE S SEATTLEWA98144 J 9 33
12 � SHADE IN DAMAGED AREA
7 j FROM TO
LIABILITY INSURANCE INSURANCE CO FARMERS 190431488 q"i"Olx
IN EFFECT &POLICY# 1
EHICLE 34
13 4 LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTUM
STANDING } 7
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY 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 REdUiR rD IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YEs NO YES NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE rnr VIN# 39
PLATE#
20 ❑ TRAILER' STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ ❑ 41
TRLR TRLR
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 AREA 43
3 4 71
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LECALLv
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.
BENJAMIN FLICK 04-18-23 06:59 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 12825 O#II,WA0171300 APPROVED BY
41119/2023 PAGE F OF 5
3000-345-013(R 11118)
REPORT NO. ED52569 CASE# ' 23-4366 DATE AND TIME 04/18/23 15:44
OF COLLISION
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