HomeMy WebLinkAbout23-8228 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED82455 170
27
COLLISION REP FIT 1591971
CASE 23-8228 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 CITY# ❑
cowsloN 07 - 18 - 2023 0821 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON RD S BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S B W e S PUGET DR
1 2 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:5039560016 1 2 30
6� LAST NAME RICHARDSON FIRSTNAME CODY MIDDLE J 1 2 31
INITIAL
STREET ❑✓ 1300 S PUGET DR#501 CITY RENTON ST WA 2jp, 98058 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 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� CDH5045 sTArI WAurN# 19UU61F54FA010474
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2015 MAKE ACUR MODEL TLX STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 1 34
13 2 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO RYLIE MANN 2111113RD AVENUE CTE SPANAWAYWA 98387 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO DAIRY LAND 11408486689 3 4
IN EFFECT &POLICY# 9TOP
VE"'CE
15❑ 5 36
LEGALLY YES❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ cvcLE ❑ ❑ OWNER [:]EA.
YEs No ,/ D:2533070573
16 a
LAST NAME GAMES FIRST NAME COURTNEY MIDDLE N
INITIAL
17❑ STREET -[1632 PIERCE AVE SE CITY RENTON ST WA ZIP 98058 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I NoF YES t l NOF,—/]
19 LDI IVE STATE WA ]SEX IF M D.C.B. 04 21 1991 39
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE I BXT8944 TAre WA VIN1t KMHDU46D88U560503
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
GI
VEH YEAR 2008 MAKE yyUN MODEL ELANTRA STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO USAA 047286046R71019IN I 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED82455
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8228
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MANN RYLIE E
(IAST FIRST,
ADDRESS&PHONE#
25513 33RD AVENUE CT E SPANAWAY WA 983879332 5037589527 SEXi F MMDDYyry 10 - O6 - 2000
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ R, 1 POS. 3 2 4 1 USE 2 CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
BEd MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.
MMDDYYYY. —
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Unit 1 was traveling behind Unit 2 westbound on S Puget DR both intending to turn right onto
northbound Benson RD S. Unit 3 was traveling northbound on Benson RD S approaching the
intersection with S Puget DR intending to continue northbound. Unit 1 and Unit 2 were in a right turn
lane that merges with northbound Benson RD S as two lanes initially northbound on Benson RD S
before the right lane merges into the dedicated single northbound lane. Driver 2 states she observed
traffic already on northbound Benson DR S in this dedicated lane and slowed and stopped to gain
time and space to merge before the lane ended. Driver 1 states Unit 2 was somehow upset with him
and was "brake checking him" and throwing her arms in the air to show displeasure. Driver 2
disputes this claim. Unknown the exact events prior to the collision. Regardless, Driver 1 stated that
he was upset with Unit 2 unnecessarily stopping in the roadway and perceived signs of displeasure
and went to pass Unit 2 on the left entering the dedicated northbound Benson DR S lane and stated
he did not see Unit 3 which was approaching. This passing on the left was the proximate cause of the
collision. As Unit 1 made this pass on the left it turned into the path of Unit 3 and the front driver's side
of Unit 1 struck the rear passenger side of Unit 3. This diverted Unit 1's course and the front
passenger side of Unit 1 then struck the rear driver's side of Unit 2. All Unit's sustained moderate
damage. This report is to document the circumstances of the collision and statements of the drivers.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-18-23 03:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/24/2023 11:29:30 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED; 8i23 AM TIME POLICE ARRIVED 8:30 AM
PART I PAGE IT]OF 4�
SUPPLEMENTAL REPORT NO. ED82455
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-8228
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 _) PEDESTRIAN � OWNER � YES NO
D:2069310450
rFO 1 29
LAST NAME JONES FIRST NAME ELANE MIDDLE
INITIAL
STREET 30
NEW AnDRFSP' 18718 111TH PL SE CITY RENTON ST WA ZIP 980557181
6
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv', 09 - 05 - 1985
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY I 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE ALV6298 [TAT WA VIN# YV4CM592761267817
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.It VIN.#.
11 3 5 VEH.YEAR2006 MAKE VOLV MODEL SC90 STYLE SD I VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1G P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNED BY DRIVER rj 1 33
12 � SHADE IN DAMAGED AREA
7 j FROM TO
LIABILITY INSURANCE INSURANCE CO ALLSTATE 976948768 gTOp
IN EFFECT I POLICY# 1
EHICLE 34
13 ❑ LEGALLY YES❑ NO❑ CITATION# CHARGE 0 BOTTUM
STANDING } 8 7 6
14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
STRE
16 NEW ETETnnR"Fl CITY ST ZIP
CDL IGNITION REdUiRED 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
LECALLv
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.
K.LANE 07-18-23 03:49 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 10008 O#IL WA0171300 JACOBS 712412023 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. ED82455 CASE# 23-8228 DATE AND TIME 07/18/23 08:21
OF COLLISION
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