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Home My WebLink About23-5591 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 23-5591 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cawsloN 05 - 1-- 2023 2016 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ MAPLE VALLEY HWY BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5 ❑ FEET e S ❑ W e 140THWAYSE ❑ 0 3 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2062908421 0 11 30 6❑ LAST NAME HARLOW FIRSTNAME NYNA MIDDLE G 1 2 31 INITIAL STREET ❑, 12463 177TH PL SE CITY RENTON ST WA ZIP 98059 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'F MID .O B 09 1- 29 - 2005 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 aTES� B65848U sTArI WAVIN# 187Ht48X22S513017 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR. 5 3 33 12 0 0 VIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 7 $ 34 13 2 2002 DODG DAKOTA PK DAMAGE vE6 ONO f �AWkkRS vEs❑ No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 14 LIABILITY INSURANCE INSURANCE CO USAA 0204 291 02G 35 IN EFFECT &POLICY# � 9TOP VE— CHARGE 36 LEGALLY Yes❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 8 7 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE 16 UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4258301444 a LAST NAME HANGER FIRST NAME MYLIE MIDDLE G INITIAL 17 NEW STREETR 19826 S 7 E 192ND ST CITY RENTON ST WA ZIP 98058 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK vEs It I NOF YES t l NOF,/ 19 LDI IVEW # STATE WA SEX F M MD D.C.B.B. 04 21 2003 39 20❑ ON DUTY STATUS I AIRBAG 6 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑21❑ PLATE# BYK5366 TArE 41 WA VINE 3VWSW31C26M421349 1 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. TOWED By Gov HI 44 VEH YEAR 2006 MAKE YOLK MODEL p/E(i(/ STYLE 3P —FEHICLE TOWED✓ NOO BLIN BANKERS YES No�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE I PORGY#E CO pROGRESSIVE 954360331IN STOP 5 VE—LE ❑ ,J� CITATION# CHARGE 25 to BOTTOM LEGALLY YES N`L J ' a 7BRYAN NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26GROZAV 12489 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED61935 COLLISION REPORT III III III III III 111 1591972 CASE# 23-5591 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 PM 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. BRYAN GROZAV 05-18-23 01:40 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 512012023 11:32:02 AM BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED! 8:29 pry] TIME POLICE ARRIVED',8:Y7 pry] PART Ei PAGE IT]OF REPORT NO. ED61935 CASE# 23-5591 OF COLLISION 05/17/23 20:16 OF CbLLI510N NARRATIVE CASE 23-5591 This incident was captured on my body worn video camera. This report is a summary of events that occurred and is not an exact sequencing of events. On Wednesday May 17th, 2023, at approximately 20:11, 1 responded to a 911 call regarding a three- vehicle collision at Maple Valley Hwy and 140th Way Se within the City limits of Renton, King County, Washington. *** CALL REMARKS: 3 MVA, LINK INJ. POSS BLKING MIDDLE TURN LANE... RP NO LONGER HAS VISUAL. RED VOLK PULLED OVER TO THE SHOULDER...**CORR 2 VEHS BLOCKING THE TURNING LANE. -UNIT ONE: GRAY 2006 DODGE DAKOTA PICKUP WASHINGTON LICENSE: B65848U -UNIT ONE DRIVER: NYNA G. HARLOW(DOaB: 09.29.2005) -UNIT TWO: RED 2006 VOLKSWAGEN NEW BEETLE WASHINGTON LICENSE: BYK5366 -UNIT TWO DRIVER: MYLIE G. HANGE (DOB: 4.21.2003) -UNIT THREE: BLACK 2012 TOYOTA SCION XB WASHINGTON LICENSE: -UNIT THREE DRIVER: STEPHANIE I SCHUMACHER (DOB 10.07.1991) 1 arrived on scene and contacted the involved parties and confirmed there were no injuries. Nyna stated she took a right turn onto Maple Valley Hwy and was struck by unit two which caused her to spin out of control and end up in the left-hand turn lane. Nyna did not report any injuries and was the sole occupant in the vehicle at the time of the crash. Mylie stated she was traveling east bound on Maple Valley Hwy when unit one turned in front of her, she tried to avoid crashing into the vehicle but couldn't avoid it. Mylie struck unit one which caused it to spin and stop in the left-hand turn lane. Mylie did not report any injuries and was the sole occupant in the vehicle at the of the crash. After speaking to Mylie, I contacted Stephanie who reported she was traveling west on Maple Valley Hwy in the left turn lane to turn onto 140th Way Se when unit one spun out of control and stopped in her lane causing her to crash into the vehicle. Stephanie did not report any injuries and was the sole occupant in the vehicle. All three involved vehicles had to be towed due to the significant damages suffered from the crash. I provided all involved parties a copy of the SECTOR exchange of information form. This concludes my involvement in this case. I certify/declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by B. Grozav #12489 on 5.18.2023 at 01:13 hours in Renton, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED61 935 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-5591 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 DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ D:4252202281 rOF 1 29 LAST NAME SCHUMACHER FIRST NAME : STEPHANIE MIDDLE' INITIAL STREET 30 ❑ NEW AnnRFrtP 11322 32ND ST NE CITY LAKE STEVENS ST WA ZIP 98258 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31 INTERLOCK YEs NO✓ zERLOCK YES❑N0 f✓ vES N ✓ DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 10 TOE] - 1991 7 ON DUTY� STATUS AIRBAG' 6 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE AJB3167 TAr WA VIN# JTLZE4FEXCJ018091 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.It VIN.#. 11 0 0 VEH.YEAR2012 MAKE TOYT MODELSCIONXB STYLE UT VEHICLE TOME ET SABLI BY anvi vFH1CP FROM TO DAMAGE YES✓NO YES NO ✓ REGISTERED OWNER INFO OWNED BY DRIVER 3 ] 33 12 � SHADE IN DAMAGED AREA J 4 FROM TO LIABILITY INSURANCE INSURANCE CO IN EFFECT &POLICY# 91QI' vEHICLE i o BDrroM 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE pp�� STANDING S} g 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME INITIAL IAL ❑ 36 STREET 16 NEW AnntxFs� CITY ST ZIP CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK 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 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEGALLv 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. BRYAN GROZAV 05-18-23 01:40 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26F7 OI BADGE 12489 O#I',WA0171300 SCOTT 512012023 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. ED61935 CASE# 23-5591 DATE AND TIME 05/17/23 20:16 OF COLLISION Z, NOT TO SCALE •6. 140th WAY SE i.� 8 as e MAPLE VALLEY HWY PAGE 5 OF 5