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Home My WebLink About23-5692 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-5692 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 2$ 1 0 RESERVATION TRIBAL UNITS 03 STRUCK z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CowsloN 05 - 20 - 2023 1922 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SW 43RD ST BLOCK NO. e --- 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 100 00 FMILES EET e S ❑ W e OAKSDALEAVESW 0 1 29 R PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES ,/No D:3252015366 2 01 30 6� LAST NAME GREWAL FIRSTNAME REENA MIDDLE 1 1 2 31 INITIAL STREET El 4836 W MERCER WAY CITY MERCER ISLAND ST I WA 2jp, 98040 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I INTERLOCK YES[:]NO NTERLOCKYEs Z/NO YEs �No / LRIIVERS STATE WA SEX'F M .O B 01 $❑ - 31 - 1961 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 aT�s� ANK2116 sTAT� WAvrN# 2T2HA31 U15C055598 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR. TRLR 1 5 33 vIN# 12 3 5 ' YIN# FROM TO VEH.YEAR 2005 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 4 LEXS RX 300 UT DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO REENA GREWAL 4836 WMERCER WAY MERCER ISLAND WA 98040 D:3252015366 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO STAE FARM 4960709A1647 4 IN EFFECT &POLICY# 9TOP VEHICL' CHARGE 1 5 36 15❑ LEGALLY STANDING YES❑NO❑ CITATION# 1 o BOTTOM 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062286294 16 a LAST NAME DEN HERDER FIRST NAME ALEXIS MIDDLE R INITIAL 17 STREET I❑ s❑' 18635 175TH AVE SE CITY' RENTON ST WA ZIP 98059 4❑ 37 NEW ADOREs 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YYEEsI I I NOF YEs t l NO� 19 DRIVERS # STATE WA SEX F MMor w 07 O6 _ 1993 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# BID4709 TATE WA vIN# 41 JF2GTAMC8JH227389 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2018 MAKE SUBA MODEL CROSS'T STYLE 4W VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO ALEXIS DEN HERDER 18635175TH AVE SE RENTON WA 98059 D:2062286294 VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU8 PORGY#E CO ALLSTATE 967906757IN 1UQ'E""LE ❑ ,J� CITATION# CHARGELGALYYES N`L J25 7TRADER NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 4553 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED65020 COLLISION REPORT III III III III III 111 1591972 CASE# 23-5692 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) ALBUQUERQUE SIMRAN (LAST FIRST, ADDRESS&PHONE# 4836 W MERCER WAY MERCER!STAND WA 98040 3252015366 SEXi F MMDDvyvv 04 - O6 - 2005 PASSENGER L,WITNESS UNIT# 1 POS 3 AIRBAG 2 RESTR, 4 EJECT ? 1 HELMET NATURE OF INJURIES USE 2 CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) BORILLO SHAWN G ADDRESS&PHONE# D O E4 11674 SE 189TH PL RENTON WA 98058 2063348552 SEX M MMDDvvvv 04 _ 24 _ 2005 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER P]WITNESS UNIT# 3 pOS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 NAME (LAST FIRST,MIDDLE INITIAL) GALLARDO CAROLINA B ADDRESS&PHONE# 11674 SE 189TH PL RENTON WA 98058 2063348552 SEX F D.o.B. 09 24 _ 1932 MMDDYYYY _ PASSENGER WITNESS UNIT# ! 3 SEAT 1 3 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES ❑ POS. USE CLASS NARRATIVE' I spoke with the drivers of all three vehicles and they conveyed the following. Unit 1 was driving EB in the 1100 block of SW 43rd ST, in the City of Renton, County of King. Unit 1 was in the turn lane preparing to change lanes when Unit 2 crossed over into her lane and struck her vehicle. Unit 2 then over corrected and went from the number two lane into the curb lane striking Unit 3. There were no injuries. No citations were issued at the scene. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. J.TRADER 05-24-23 10:35 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.TOLLIVER 10540 1 512912023 11:00:21 PM BADGE OR ID# 4553 OR]#' WA0171300 TIME POLICE DISPATCHED; 7:37 Pry! TIME POLICE ARRIVED',7:38 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. ED65020 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-5692 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:2063348552 OF 1 Zg LAST NAME FIRST NAME MIDDLE t;ALLARDO AMABEL INITIAL, '' B STREET 30 NEW AnDRFSP' 11674 SE 189TH PL CITY RENTON ST WA ZIP 98058 5 ❑ 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED INTERLOCK YEs NO NTERLOCK YES❑N0� YEs N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 08 - 14 - 1970 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE I CEA7659 [TAT WA VIN# 5FNYF6H26NBO56043 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR MAKE MODEL STYLE VEHICLE TOME E T SABLIN TOWED BY anvi vEH1C P FROM TO 2022 HOND PILOT EX UT DAMAGE YES NO YES NO REGISTERED OWNER INFOAMABEL GALLARDO 11674 SE 189TH PL RENTONWA 98058 D:2063348552 SHADE IN DAMAGED AREA 7 3 33 12 z 3 FROM TO LIABILITY INSURANCE INSURANCE CO MUTUAL OFENUMCLAW AA80139780 GQ IN EFFECT &POLICY# 1EHICLE 34 13LEGALLY YES❑ NO❑ CITATION# CHARGE STANDING S} qg 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER RTY YES[—]AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME NIDT L ❑ 35 STREET 16F] NEW STRE "F-]' CITY ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YEs NO E 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE# STATE 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 LERICLE 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. J,TRADER 05-24-23 10:35 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 25 OR ID# 4553 O#I',WA0171300 TOLLIVER 512912023 PAGE�OF 4 3000-345-013(R 11118) REPORT NO. EU85020 CASE# 23-5682 DATE AND TIME 05/20/2310:22