HomeMy WebLinkAbout23-5033 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-5033 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&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#
cowsloN 05 - 1-- 2023 0925 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY N BLOCK NO. e✓ 1400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OFHOUSER WAYN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2536326317 0 11
30
6� LAST NAME JOHNSON FIRSTNAME DANIEL MIDDLE R 1 2 31
INITIAL
STREET ❑ 21103 7TH STREET CT E CITY LAKE TAPPS ST WA Zjp, 983915608 z
'NEW ADDRESS
7❑ CDL I 1/ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO NTERLOCKYEs NO Z YEs No�/
8❑ LRIIVER #
[ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� BXH3776 sTArI WAurN# 1C4SDJCT8LC130362
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 ] 34
13 2 2020 DODG DURAN UT DAMAGE vE8 ONO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO WHITNEYLOKEN 211037TH STREET CTE LAKE TAPPS WA 98391 D:2536326317 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO GEICO 4431529827
IN EFFECT &POLICY# 9TOP
15❑ LE
vECAIIv HIa.E 5 36
res❑NO❑ CITATION# CHARGE BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064912139
16 a
LAST NAME WILLIAMS FIRST NAME HARVEY MIDDLE A
INITIAL
17❑ NEW STREETR 15400 S
7 E 155TH PL UNIT 52 CITY RENTON ST WA ZIP 980586352 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVERS STATE WA SEX M M D.C.B. 11 27 1964 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BZV2652 TArE 41
WA VIN# 1HGCM56304A169534 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2004 MAKE HOND MODEL ACCORD STYLE QD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO HARVEY WILLIAMS 15400 SE 155TH PL UNIT 52 RENTON WA 98058 D:2064912139 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO FARMERS 186442220IN STOP 5
vEwGLE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 a
=UGENT
(Nu
PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED57386
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5033
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LOKEN WH/TNEYD
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
21103 7TH STREET CT E LAKE TAPPS WA 98391 2536326317 SEXi F MMDOYyry 05 - 18 - 1987
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER Z WITNESS� UNIT# 1 POS 3 AIRBAG 2 RESTR. 4 EJECT USE 2 CLASS 7 C/O GENERAL SORENESS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# SEX MMDDYYYY DOB
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY 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.
MATTHEW NUGENT 05-04-23 03:12 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
Co. IOHNSON 0505 151512023 10:31:40 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 9:29 AM TIME POLICE ARRIVED:9:41 AM
PART I PAGE IT]OF 4]
REPORT NO. ED57386 CASE# 23-5033 OF COLLISION
05/04/23 09:25
OF CbLLI510N
NARRATIVE
23-5033
On 05/04/2023 at approximately 0929 hours, I was dispatched to a blocking vehicle collision at the
intersection of Bronson Way N and Houser Way N, within the City Limits of Renton, County of King,
State of Washington.
Upon my arrival, 1 contacted the involved parties and confirmed there were no complaints of injury
requiring immediate medical response at the time of report. While on scene, I collected each involved
party's driving information and their independent recollection of the incident.
The driver of Unit#1 said he and his adult passenger were traveling northbound on Houser Way N
approaching the intersection of Bronson Way N in lane 4 of 4. The driver of Unit#1 stated he saw the
green traffic light for lanes 1-3 of 4 to make an eastbound turn onto Bronson Way N, however lane 4
is its own controlled traffic lane. The driver of Unit#1 stated he did not realize his lane of traffic was
red and proceeded northbound through the intersection with the intent to continue north onto Houser
Way N. While continuing through the intersection, he collided with Unit#2 in the intersection causing
significant damage to the front axle on the passenger side of Unit#1. The driver of Unit#1 admitted
fault for not paying attention to the traffic signal.
The driver of Unit#2 said he was the sole occupant of his vehicle and was traveling westbound on
Bronson Way N approaching the intersection of Houser/Factory Way/Ave N in lane 1 of 2. The driver
of Unit#2 stated he was intending to continue west on Bronson Way N. The driver of Unit#2 stated
that the traffic light was green for his lane of travel and therefore he continued through the
intersection. While in the intersection, Unit#2 stated that Unit#1 had pulled out into the intersection
from the south and that he was unable to avoid collision contacting the front of Unit#1 with the front
of his vehicle causing moderate damage to the front bumper of Unit#2.
Based on the above statements, 1 determined that the Driver of Unit#1 (Johnson) was the
predominant factor for the collision as Johnson was not paying attention to the traffic control device
for his lane of travel causing a collision.
Unit#1 had to be impounded due to significant damage. Unit#2 was able to be driven away without
further incident. 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 M. Nugent#11498 5/4/2023 3:11 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED57386 CASE# 23-5033 DATE AND TIME 05/04/23 09:25
OF COLLISION
z
8ronsot+WaYN a m�ma�
PAGE 4 OF 4