HomeMy WebLinkAbout24-4321 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE#r` 24-4321 z
INTERSTATE ❑ CITY STREET FIRE R� 675
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3 6 6
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 - 1-- 2024 1516 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
AIRPORT WAY BLOCK NO. e✓ 400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e LOGAN AVE N
2 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:5419007084 0 11
30
6� LAST NAME CHAMBERS FIRSTNAME LATHAM MIDDLE J 1 2 31
INITIAL
STREET ❑ 3163 SE 4TH ST CITY RENTON ST WA 21p 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ DRIVERS
E#
[NATURE OF INJURIES
9 ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H U SE CLASS 6 LEFT HIP AND LEFT LEG z❑
3
10 9❑ P1 AT 14 CHT2542 STATE WA VIN# JM1FE173440120830
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 6 7 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 7 $ 34
13 8 2008 MAZE) RX8 2T DAMAGE vEs 0NO agW�MEYERS vEs❑ No
REGISTERED OWNER INFO BRYAN PAPUNS.3163 SE 4TH ST RENTON WA 98056 D:5412526837 VEHICLE NO. 1
SHADE IN DAMAGED AREA � 35
8 INSURANCE CO 2
14 LIABILITY INSURANCE� USAA 0215435707104
IN EFFECT &POLICY# � 9TOP 5
vE EFFECT
CHARGE 10BOTTOM 36
LEGALLY YES❑NO CITATION# 4g0359111 INT LICENSE-PASSENGER UNDER 20
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066053083
16 2
LAST NAME SUBER FIRST NAME IAN MIDDLE E
INITIAL
17 STREET I❑ S❑' 11255 5 4❑7TH AVE S CITY' RENTON ST' WA ZIP 98178 37
NEW ADDRES
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX M M .C.B. 05 _ 10 _ 1987 39
20❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES ❑ 40
USE CLASS POSSIBLE CONCUSSION
LICENSE I ❑21❑ PLA E# C55474L TATE 41
WA VIN# 5TBBT44122S252707 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2002 MAKE TOYT MODEL TUNDRA STYLE PK VEHICLETOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYERS YES NO
REGISTERED OWNER INFO IANSUBER1125557THAVES RENTONWA98178 D:2066053083 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO GEIC04164-93-85-59IN 1 5
—e E ES❑ N,J� CITATION# CHARGEUR
LEGALLY Y
25 7NICH
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SWAN 12965 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE72692
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4321
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PINERA NOAH Z
(LAST FIRST,
ADDRESS&PHONE# D O.B.
17818 97TH AVE S RENTON WA 98055 4255242654 SEX M MMDouyvv 02 - 21 - 2008
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 1 POS 3 1 AIRBAG 6 RESTR. 4 I EJECT I 1 USE CLASS 16 RIGHTARM,RIGHT LEG,BACK OF
HEAD
NAME
(LAST,FIRST,MIDDLE INITIAL) RYAN NATHAN T
ADDRESS&PHONE# D O B
3710 LAKE WASHINGTON BLVD N RENTON WA 98056 2067940477 SEX M MMaDYvvv 03 _ 12 _ 1998
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[:]WITNESS POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.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.
NICHOLAS SWAN 04-20-24 08:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 4/30/2024 9:52:56 AM
BADGE OR ID# ( 12965 OR]# WA0171300 TIME POLICE DISPATCHED; 3:44 PM TIME POLICE ARRIVED]3:48 PM
FART I PAGE IT]OF 4�
REPORT NO. EE72692 CASE# 24-4321 OF COLLISION
04/20/24 15:16
OF CbLLI510N
NARRATIVE
On 04/20/2024 at approximately 1344 hours, I was dispatched to a non-injury, 2 vehicle, blocking
collision at the intersection of Airport Way and Logan Ave N, within the City Limits of Renton, County
of King, State of Washington.
Upon arrival, I contacted the involved parties and both reported injuries that required aid. Aid was
called and responded to check out the involved parties. There, I collected the involved parties driving
documents and their independent recollection of events leading up to the collision.
The driver of Unit#1 said he was traveling southbound on Logan Ave N when he took the corner from
Logan Ave N on to Airport Way in lane 2 and struck the center curbed median, causing his vehicle to
lose control and do a 360 into oncoming traffic on Airport Way. The driver of Unit#1 said he did not
believe he was speeding, but merely overcorrected on the corner after hitting the curb which caused
him to do the 360. The driver of Unit#1 did have a passenger in his vehicle. The driver of Unit#1 is
also on an Intermediate License which does not yet allow him to have non-family passengers under
the age of 20.
The driver of Unit#2 said he was the sole occupant of his vehicle and also traveling eastbound on
Airport Way in lane 2. The driver of Unit#2 stated he was driving down the lane and all of a sudden
saw Unit#1 spin out of control and strike his vehicle causing significant damage. Unit#2 was
transported to the hospital for further treatment after being checked out at the scene by aid units.
A witness at the scene, identified as Nathan T Ryan DOB 03/12/1998, confirmed the events that Unit
#2 described above. Nathan was traveling behind Unit#2 when the accident happened and
confirmed the speed at which he and Unit#2 were both traveling. He also confirmed seeing Unit#1
lose control and do a 360 type spin in his vehicle.
Based on the above statements, 1 determined that the Driver of Unit#1 (Chambers) was the
predominant factor for the collision due to negligent driving. Chambers should have been driving less
aggressively.
Unit#1 was towed away from the scene. Unit#2 was also towed away from the scene. A citation was
issued to Unit#1 for an Intermediate License violation. An exchange of information was provided to
all involved parties.
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 N. Swan #12965 1929 hours on 04/20/2024 in Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EE72692 CASE# ' 24-4321 DATE AND TIME 04/20/24 15:16
OF COLLISION
�`riye=
T
Y
l � �
t. d
PAGE 4 OF 4