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Home My WebLink About23-7080 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 23-7080 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4150 3 HIT 8 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 06 - 1-- 2023 0815 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ S GRADY WAY BLOCK NO. e✓ 200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:4252601180 0 81 30 6� LAST NAME SAND FIRSTNAME CHRISTINA MIDDLE J 1 1 2 31 INITIAL STREET ❑✓ 2706 NE 5TH CT TON WA NEW ADDRESS ST zIP', 98057 2 CITY REN 7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET ICNLJU:SY 0 NATURE OF INJURIES z❑ 3 10[1P1 ATNES# ATW0566 sTAT WAv N# 3HGGK5H56FM741248 0 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 3 0 VIN#' VIN# >; FROM TO VEH.YEAR 2015 MAKE HOND MODEL FIT STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE 9 9 34 DAMAGE YES NO YES[:] NO✓ 13❑ REGISTERED OWNER INFO RYANSAND2706NESTHCTRENTONWA98056 VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE z INSURANCE CO PEMCO INS CA 1364875 4 LI EFFECT I POLICY# TOPVENICLE CHARGE 36 LEGALLv res❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:5099999314 16 a LAST NAME SHAW FIRST NAME SARAH MIDDLE IM INITIAL 17❑ STREET � 24005 SE 196TH ST CITY' MAPLE VALLEY ST WA ZIP 98038 37 NEW ADDRESS I i ❑ 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 DRIVER'S STATE WA SEX F D.O.B. 07 21 1982 0 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I GU01982 TATe WA VIN# 5TDEBRCH7LS012055 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2020 MAKE TOYT MODEL HIGHLAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO SARAH SHAW 841 EAST LN KENT WA 98030 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE 8 POINSURGY#E CO PEMCO INS CA 1001752IN VE""LE CITATION# CHARGEE,�� LEGALLY YES N� 25❑ J s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 J.M/TCHELL 10377 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED76149 COLLISION REPORT III III III III III 111 1591972 CASE# 23-7080 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME(LAST FIRST,MIDDLE INITIAL) SHAW L ADDRESS&PHONE# D O.B. ' MAPLE VALLEY SEX' MMDDYYYY 09 - 18 - 2019 PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ 2 POS. 6 2 11 1 USE CLASS 1 NAME '(LAST,FIRST,MIDDLE INITIAL) SHAW H ADDRESS&PHONE# DOB MAPLE VALLEY SEX' F MMDDYvvv 11 _ 09 _ 2021 SEAT HELMET I INJURY NATURE of INJURIES PASSENGER Z WITNESS UNIT# 2 POS 4 AIRBAG 2 RESTR. 11 EJECT 1 USE CLASS 1 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' On 062223 1 responded to a 3-vehicle non-injury/blocking collision at 200 block of S Grady Way. I contacted the driver of unit 1 who told me they were traveling in the #1 lane of westbound S Grady Way. She believes after possibly having a seizure, she rear-ended unit 2. The impact of that collision pushed unit 2 into the back of unit 3. Unit 2 and 3 were stopped in the lane due to a red light at the traffic signal at Rainier Ave S. Driver of unit 1 was checked out by Renton Fire at the scene. She did not require transport to a medical facility. Her vehicle was towed due to front-end damage. I contacted the drivers of unit 2 and 3. Both confirm they were stopped in the lane for traffic light. There were no reported injuries by the drivers of unit 2 and 3. Damages were minimal to both. But not for the action of UNIT 1 DRIVER the result would not have happened. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. J.MITCHELL 06-22-23 10:23 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 7/3/2023 3:15:35 PM BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED; 8:15 AM TIME POLICE ARRIVED 8:20 AM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. ED76149 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-7080 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:4255476539 OF 8 29 LAST NAME MORALES FIRST NAME : SANDRA MIDDLE'.. P INITIAL STREET 1 r:i 30 NEW AnDRFSP' 12835 SE 160TH ST CITY RENTON ST WA ZIP 980584716 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs No NTERLOCK YES�NO� YEs N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv', 12 - 26 - 1978 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE I CAB4753 [TAT WA VIN# 3N1CN8EV9ML843806 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 0 VEH.YEAR2021 MAKE NISS MODEL VERSA STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1G P FROM TO DAMAGE YES NO YES NO 33 REGISTERED OWNER INFOSANDRA MORALES 12835 SE 160TH ST RENTON WA 98058 SHADE IN DAMAGED AREA R 9 12 a FROM TO LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYINS 410618608373 gTOp IN EFFECT &POLICY# 1 EHICLE o BarroM 34 13 LEGALLY YES NO 01 CITATION# CHARGE STANDING �}� 8 7 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 35 15 LAST NAME FIRST NAME INITIALAL MDDLE ❑ ET 16 STRETRE "F ' CITY ST ZIP NEW CDL IGNITION REOUIREE7 IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ TRLR TRLR 41 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 LEwcLE 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,MITCHELL 06-22-23 10:23 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 25 ORID# 10377 O#I',WA0171300 JACOBS 7/3/2023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. ED76149 CASE# ' 23-7080 DATE AND TIME 06/22/23 08:1 5J OF COLLISION AV IML 5 GRADY WAY niolmmmm=I PAGE 4 OF 4