HomeMy WebLinkAbout23-5833 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-5833 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 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 0427 17 ❑. S 8 W Li OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 1900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4062003407 0 11
30
6� LAST NAME RELFORD FIRSTNAME GARY MIDDLE D 1 2 31
INITIAL
STREET ❑, 1906 MCHUGH AVE CITY ENUMCLAW ST WA ZIP 98022 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE C14500K sTArr WAurN# 3GCUKREC6HG210340
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 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 TOWED By GOVT.VEHICLE 3 7 34
13 2 2017 CHEV SILVER TR DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑
14 LIABILITY INSURANCE INSURANCE CO USAA 0466551477101 35
4
IN EFFECT &POLICY# 9TOP
15❑ vewcLE 5 36
LECALLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES,/ No D:3605409545
16 a
LAST NAME PARKER FIRST NAME JEFFREY MIDDLE I L
INITIAL
17 NEW STREETR 7' 25439 SE 208TH ST CITY MAPLE VALLEY ST WA ZIP 98038 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK yEs❑NOF YEs❑NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 07 21 1966 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# 1ADEM12 TArE 41
WA VIN# 1G1Y62D44N5113443 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH D
YEAR 2022 MAKE CHEV MODEL CORNETT STYLE CP AMAGE TOWED ES NOO✓ BLIN TOWED BY ovyES NO,/ 44
H
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE &POINSURGY#E CO THE GENERAL 53-WA-9970421IN I STOP 5
VEHICLE ❑ CITATION# CHARGE
LEGALLYNC[:] to BOTTOM
YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED63587
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5833
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SAWYER THOMAS L
(LAST FIRST,
ADDRESS&PHONE# D O.B.
116 SEMANSKI ST A ENUMCLAINWA 98022 2532312098 SEX M MMDDYyry 09 - 08 - 1995
PASSENGER RVWITNESS❑ UNIT# 1 POST 3 AIRBAG 2 RESTR. 9 EJECT ? 1 H U SE 2 `CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D Q 8
SEXt MMDDYyYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 05-24-2023 1 was working as a police officer in the city of Renton. At approximately 0436 hours I
was dispatched to the report of a collision near Sharis Restaurant, 1820 Maple Valley Hwy, City or
Renton, County of King, WA. This incident was captured on my department issued Axon body
camera.
According to the notes in the call, there was a two vehicle collsion with no injuries. Both involved
parties called in and were parked in the Sharis parking lot. I arrived on scene with multiple officers
already on scene. I confirmed there were no injuries.
I spoke with Jeffrey L Parker (DOB: 07-21-1966) about the incident. He said he was driving Unit 2 in
the outside lane travelling west on Maple Valley Highway. He noticed Unit 1 changing lanes into his
lane of travel. Unit 1's passenger side wheel and foot railing collided with Unit 2's driver side door and
rear view mirror. The collision forced Unit 2 towards the curb, which damaged the passenger side
wheels.
The driver of Unit 1, Gary D Relford (DOB: 01-06-1064), told me a similar story. Gary was driving
west and attempted to change lanes to the right. He believed the lane was clear so he started
merging. Once he started merging he stated Unit 2 sped up causing the collision.
I photographed the damage to both vehicles and uploaded the photographs to Evidence.com.
Based on the investigation and totality of the circumstances I believed Unit 1 did not grant the right of
way causing the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
STEVEN FAJARILLO 05-24-23 07:13 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 512512023 5:33:55 AM
BADGE OR ID# ( 12847 OR]# WA0171300 TIME POLICE DISPATCHED; 4:27 AM TIME POLICE ARRIVED'4:36 AM
FART I PAGE IT]OF 3�
REPORT NO. ED63587 CASE# 23-5833 DATE AND TIME 05/24/23 04:27
OF COLLISION
�a
NOT TO SCALE
4
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