HomeMy WebLinkAbout23-8487 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED85545 170
27
COLLISION REP FIT 1591971
CASE 23-8487 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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#
GawsloN 07 - 1-- 2023 1424 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
OAKESDALEAVE SW BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SWGRADYWAY
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:2067330425 0 4 30
6 LAST NAME MONTANO ARAUJO FIRST NAME MARIO MIDDLE A 1 1 2 31
INITIAL
STREET ❑✓ 6003 45TH AVE CT E CITY TACOMA ST WA ZIP, 98443 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs No�/
8❑ LRIIVER # STATE WA SEX'M MI D Y' 12 - 31 - 1990 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 2 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� C14667X sTATI WAVrN# 3AKBCYFE4JDJT7641
TRAILER 04504AH STATE WA TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 5 7 33
12 3 5 vIN#'3H3V532C1CT081004 vIN#
i:... FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN I TOWED BY GOVT.VEHICLE 5 ] 34
13 2 2018 FRHT M2-106 DAMAGE YES fn TO YES[:] H
REGISTERED OWNER INFO SEA TAC EXPRESS INC.330 SW43RD ST STE K329 RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO NORTHLAND INSURANCE WFOO9621 3 4
IN EFFECT &POLICY# Q
VeNICE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 1
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OL PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ D MET NO O 2063699086
16 a
LAST NAME POPKY FIRST NAME JUDITH MIDDLE K
INITIAL
17❑ STREET ❑', 6950 31 ST AVE SW CITY SEATTLE ST WA ZIP 981264205 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NOF,-/]
19 DRIVER'S STATE WA ]SEX IF D.O.B. 04 26 _ 1970 0 39
LICENSE# MMDDYY
HELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE POPOVER TATe WA vIN1t USE
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN It 'IN#.
VEH YEAR 2023 MAKE TESL MODEL MODEL Y STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO JUDITH POPKY695031STAVE SW SEATTLE WA 98126 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO ENCOMPASS INDEMNITY CO US282244438 1UQ,
5IN EFFECTVEHICLE ❑ ,.II CITATION# CHARGELEGALLY YES N25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED85545
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8487
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. 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'
Unit 1 (a semi-truck with trailer) was stopped at a red light in the center of 3 northbound lanes of
Oakesdale AVE SW at the intersection with SW Grady Way. Unit 2 was in the left of 3 northbound
lanes of Oakesdale AVE SW also at the intersection with SW Grady Way. Unit 3 was stopped for a
red light in the inside left turn lane of eastbound SW Grady Way at Oakesdale AVE SW. The lane
Unit 1 was in is a left turn or straight-ahead option lane and Unit 1 was planning to turn left onto
westbound SW Grady Way. Unit 2 was in a left turn only lane also planning to turn left onto
westbound SW Grady Way. When the light turned green, Unit 1 and Unit 2 proceeded forward to
make their left turns into their respective lanes. Due to Unit 1's configuration (towing a full-size semi-
trailer), as Unit 1 completed the left turn, the trailer drifted inward into the lane Unit 2 occupied. The
trailer tires of Unit 1 impacted front passenger side of Unit 2 forcing it inwards towards the center line.
This impact forced Unit 2 into the side of Unit 3 which was waiting at the stop light. The front driver's
side of Unit 2 impacted the driver's side of Unit 3. Unit 1 sustained minor damage to the trailer tires
on the driver's side. Unit 2 sustained moderate heavy damage to the front passenger side and minor
damage to the driver's side. This damage required Unit 2 to be towed from the scene as it was
disabled. Unit 3 sustained minor driver's side damage and as able to leave under its own power.
This report is to document the circumstances of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-25-23 09:07 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/2/2023 1:06:11 PM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 2:29 Pry TIME POLICE ARRIVED 2:32 PM
PART I PAGE IT]OF 4]
SUPPLEMENTAL REPORT No. ED85545
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-8487
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓ G
UNIT# 1 USDOT 568382 ICC# VEHICLE TYPE 6 CARGO BODY 2
TYPE
2 ❑ 1 28
CARRIER NAME SEA TAC EXPRESS INC
.......
3 CARRIER
ADDRESS 330 SW 43RD ST STE K329
CITY RENTON ST WA ZIP'', 98057
4 ❑ NAME # PLACARD: :❑
NAME IF NO NUMBER
SOURCE 1 AXLES 03 GI54000 +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- �`"'j PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO ✓
D:6142094187
0 8 29
LAST NAME HABANE FIRST NAME IFRAH MIDDLE' M
INITIAL
STREET 30
NFW AnDRFrtP 11452 4TH PL SW CITY SEATTLE ST WA ZIP 981462200
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', 07 - 10 - 1981
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE CGK1156 TAr Wq VIN# 4T1BF1FKXCU627934
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2012 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED DUE T SABLIN TOWED BY anvi vEHlci F FROM TO
DAMAGE YES NO ✓ YES NO ✓
33
REGISTERED OWNER INFOIFRAH HABANE 114524TH PL SW SEATTLE WA 98146 J 9
12 SHADE IN DAMAGED AREA
7 j 4 FROM TO
LIABILITY INSURANCE INSURANCE CO GEICO 4510000344 q"i"Olx
IN EFFECT &POLICY#
VEHICLE 34
13 ❑ LEGALLY YESZ NO❑ CITATION# CHARGE 10 BOTTOM
STANDING �} MOTOR
� 7 6
14 ❑ UNIT Tr Vd I RE O CYCLE � OWNERRTY � DASMMNOHRESHOLDMET PHONE ❑ 35
El PEDESTRIAN YE
36
15 LAST NAME FIRST NAME NII7 AL
❑
STRE
16 NFW ETETnnR"� CITY ST ZIP
CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No INTERLOCK YEs NO YEs NO El
17 37
LICENSE# STATE SEX MMDDDYSYY -� II
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE ICLASS
19 ❑ 39
LICENSE rnr VIN#
PLATE#
20 ❑ TRAILER STATE TRAILER STATE ❑ 40
PLATE#< PLATE#
21 ❑ TRLR TRLR 41
ViN# YIN#i
42
22 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED 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 '
IN EFFECT &POLICY# i 97OP - 4 44
VE
24 VEHICLE YES NO❑ CITATION# CHARGE iq 6OTiOM
LEGALLY
E:l
STANDING 8 7 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-25-23 09:07 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 10008 O#IL WA0171300 JOHNSON 8/2/2023 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. ED85545 CASE# ' 23-8487 DATE AND TIME 07/24/23 14:24
OF COLLISION
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