HomeMy WebLinkAbout23-144 ITFF' " ll� . 571
27POLCERA c III II
COLLISION REP FIT 1591971
❑ ❑ 23-144 2
RESULTED ❑ CASE
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL ': UNITS 04 STRUCK
RESERVATION'
2
3 DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 01 - 04 - 2023 0720 17 =.= S IN 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ Y200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ FEET e S ❑ W e OF,
1 29
MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE
NIT 01 VEHICLE ❑ CYCLE. ❑ YES NO F D:2065502602 0 7 30
6 LAST NAME NAMKUNG FIRSTNAME SUSANNE MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 13215 SE 166TH PL CITY RENTON ST WA ZIP 980586926 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 04 — 07 — 1969 1 2 32
9 ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES 2
3
10 9❑ P1 aT�S� C65596X sTArI WAVrN# 1FTFW1EF1CFC44964
TRAILER STATE TRAILER STATE11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE g 9 34
13 2 2012 FORD F150 DAMAGE vEsNo � �MEYER YES[:] No
REGISTERED OWNER INFO STEVEN NAMKUNG 13215 SE 166TH PL RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
rI 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 901438792 14
IN EFFECT &POLICY#vE FFE CHARGE 36
LEGALLY YEs❑No CITATION# 3AO087426 INATTENTIVE DRIVING <�Q,
15❑ STANDING 8 7 6
'j MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:4699519355
16 a
LAST NAME DHINGRA FIRST NAME GAURAV MIDDLE
INITIAL
17❑ STREET � 16640 SE 165TH WAY CITY RENTON ST WA ZIP 98058 37
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK v�Esl I I NOF YES
t l No�
19 DRIVERS
# STATE WA SEX M Mr D.C.B. 01 29 _ 1992 39
HELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE I CBP2265 TAre WA VIN# WINOG8E69MF922458
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2021 MAKE MERZ MODEL GLC STYLE —FEHICLE
TOWED✓ NOO BLIN GENE MEYER YES No�/
24
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE 954043567IN
VEHICLE CITATION# CHARGE <E��
LEGALLY YES[Z NCE
25❑ JAGENCY
s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED21835
COLLISION REPORT III III III III III 111
1591972 CASE# 23-144
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'
Unit 4, Unit 3, and Unit 2 were stopped for traffic northbound (facing west) in the 2200 blk of Maple
Valley HWY backed up from the onramp to 1-405. Unit 4 was first in the line, Unit 3 behind Unit 4, and
Unit 2 behind Unit 3. Unit 1 was approaching these Units and the stopped traffic traveling northbound
(west) on Maple Valley HWY. For unknown reasons, Driver 1 did not recognize that traffic was
stopped and was unable to stop in time to avoid the collision. The front end of Unit 1 struck the rear
end of Unit 2. The force of this collision sent Unit 2 forward and the front end of Unit 2 struck the rear
end of Unit 3. The force of that collision sent Unit 3 forward and the front end of Unit 3 struck the rear
end of Unit 4. Unit 1 sustained heavy front-end damage, Unit 2 sustained moderate front and rear
end damage, Unit 3 sustained moderate front and rear end damage disabling the vehicle, and Unit 4
sustained light/moderate rear end damage. Unit 1, 2, and 3 were towed by Gene Meyer.
Driver 1 cited for Inattentive Driving by not driving with due care and caution in monitoring the
roadway to recognize stopped traffic which was the proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 01-04-23 08:50 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1/4/2023 12:49:04 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED; 7:24 AM TIME POLICE ARRIVED 7:Y8 AM
PART B PAGE IT]OF 4�
SUPPLEMENTAL REPORT NO. ED21835
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-144
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
❑ 1 1 8 28
2
CARRIER
NAME
3 CARRIER L
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:4252418659
OF 7 29
LAST NAME GONZALEZ FIRST NAME : GABRIEL MIDDLE
INITIAL
0 7 30
STREET
NFW AnORFSP' 17818 SE 196TH DR CITY RENTON ST WA ZIP 1 980589620
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:]
YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv', 03 - 22 - 1973
7 ❑ ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 1 2 32
LICENSE 008PPR TAr WA VIN# WBAEW53463PG20279
PLATE#
9 [9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 TRLR TRLR 91 VIN.#. VIN.#.
11 4 U VEH.YEAR2003 MAKE BMW MODEL330 STYLE VEHICLE TOWE ET W,6'•ER GnVT VFHIGP FROM TO
DAMAGE Y SABLIES NO YES NO
REGISTERED OWNER INFOGASRIEL GONZALEZ 17818 SE 196TH DR RENTON WA 98058 g g 33
12 t} 0 SHADE IN DAMAGED AREA
3 4 FROM TO
LIABILITY INSURANCE INSURANCE CO SAFECO H2O55022 IN EFFECT &POLICY# C�� 9 9 34
13 ❑ VEHICLE ❑ CITATION# CHARGE
LEGALLY YES NO
STANDING 8 7 6
DAMAGE THRESHOLD MET PHONE El35
14 UNIT# 4 MdT{7R O PECAE ❑ PEDESTRIAN ❑ PROPERTY ❑ YES NO
VEHICLE CYCLE OWNER �/ D:2062718787
36
15 ❑ LAST NAME NARTEA FIRST NAME ASHLEY MIDDLE N
❑
INITIAL
2 S
16 ❑ STREETtxFS❑ 17800 SE 188TH PL CITY RENTON ST WA
NFn+Ann Z!P 980580310
CDL IGNITION REdUIRED IGNITION PRESENT MEDICALTANSPORTED
17 ❑ INTERLOCK YES No INTERLOCK YEs NC7 rEs No�/ EDRIVER'S
STATE WA SEX F D.O.B 37
LICENSE# MMDDYYY` O6 - 30 - 1989
18 ❑ E
ON DUTY STATUS' AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES 38
USE CLASS
19 ❑ LICENSE ❑
PLATE#
BRG3084 Tnr WA vIN# SALCT2BG8HH658276 39
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ TRLR TRLR 41❑
ViN# YIN#i
42
22 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE
2017 LNDR DISCOV DAMAGE YES NO YES NOZI
23 ❑ REGISTEREDOWNER INFOASHLEYNARTEA 17100SE188THPL RENTON WA 98058 SHADE IN DAMAGED AREA 43
z 3 4
LIABILITY INSURANCE INSURANCE CO GEICO 0328-71-45-06 9'1'OP
❑ EFFECT &POLICY#
VEHICLE
44
24 LE ALE YES[Z NO❑ CITATION# CHARGE iq 60TiOM
LE ALLY
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.
K.LANE 01-04-23 08:50 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 OR ID# 10008 O#IL WA0171300 JOHNSON 1/4/2023 PAGE❑OF❑
3000-345-013(R 11118)
REPORT NO. ED21835 CASE# 23-144 DATE AND TIME 01/04/2307:20
OF COLLISION
y
IL
***NOT TO ,GALE***
2200 blk MAPLE VALLEY HWY'
PAGE 4 OF 4