HomeMy WebLinkAbout23-9338 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9338 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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 N E IN CITY#
cowsloN 08 - 1-- 2023 1628 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW GRADY WAY BLOCK NO. e✓ p ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a MAPLE AVE SW
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4256521092 0 11
30
6 LAST NAME MC CREADY FIRSTNAME RICHARD MIDDLE A 1 2 31
INITIAL
STREET ❑ 2304 NE 9TH ST CITY RENTON FT WA ZIP 980562944 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 USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE C46775J sTArI WAurN# 1GBJG31U851164993
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 ZOOS CHEV EXPRES DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 06173082.8 3 4
IN EFFECT &POLICY# 9TOP
VE"'CLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2066786286
16 a
LAST NAME CAPADONA FIRST NAME ALEXA MIDDLE M
INITIAL
17❑ STREET ❑', 14640 SW MAVERICK RD CITY TERREBONNE ST OR ZIP 97760 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES
t l NOF,/
19[-] DRIVER'S STATE OR SEX IF I D.Q.B. 107_ 26 _ 1994 El 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 554LDV TAre OR vIN1 USE
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2003 MAKE CADI MODEL ESCALAD STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO GENE MEYER YES NO
REGISTERED OWNER INFO ALLISTAR MCCLAIN 14640 SW MAVERICK RD TERREBONNEOR97760 VEHICLE NO.2
SHADE DAGELLCddAREA
LIABILITY
INSURANCE &POINSURGY#E CO ESURANCEPAOR-9721420
IN CTOP
VEHICLE ❑ ,.I—J I CITATION# CHARGE to BOTTOM
LEGALLY YES N 6
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. ED89740
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9338
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MCCLA►N ZAIDEN M
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
14640 SW MAVERICK RD TERREBONNE OR 97760 SEX M MMDDvyry 03 - 08 - 2016
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ - 2 PO& 6 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) MCCLA/N IZALIYA M
ADDRESS&PHONE# D O B
14640 SW MAVERICK RD TERREBONNE OR 97760 SEX F MMDDvvvv 12 _ 15 _ 2018
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 5 AIRBAG 2 RESTR. 10 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) MCCLAIN MORDCAI G
ADDREss&PHONE# 14640 SW MAVERICK RD TERREBONNE OR 97760 SEX M M _ 17 _ 2022
MDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT q AIRBAG 2 RESTR. 10 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
pOS.❑ SEAT USE CLASS B�----�
NARRATIVE'
Unit 1 was in the center turn lane facing westbound on SW Grady Way intending to turn left onto
southbound Maple AVE SW. Unit 2 was traveling eastbound in the far right (#1) lane of three
eastbound lanes of SW Grady Way approaching Maple AVE SW. Unit 3 was stopped in traffic in the
middle eastbound lane (#2) of SW Grady Way just adjacent or just east of Maple AVE SW. The left
and center lanes of eastbound SW Grady Way (#3 and #2) had traffic stopped backed up from a
traffic signal to the east and backed up west of Maple AVE SW. The lane Unit 2 was traveling in (#1)
was a right turn only lane eventually on to SR-167 and had free flowing traffic. Motorists in the
stopped lanes #3 and #2 stopped short and made room for Unit 1 to turn left onto southbound Maple
AVE SW. Driver 1 stated they were signaling him to go and he did not realize there was a third lane
(#1), which Unit 2 was approaching in, so he began his turn. Unit 1 initiated this left turn and
accelerated towards the south just as Unit 2 lawfully entered the intersection proceeding eastbound
with the right of way. The front end of Unit 1 struck the middle/rear of Unit 2 causing moderate/heavy
damage. The force of this collision spun Unit 2 counter-clockwise with the rear end rotating up and
on to the sidewalk. These forces rolled Unit 2 over on to the passenger side and then on to the roof
with it still rotating counter-clockwise in the roadway. Before Unit 2 came to rest on its roof in the
roadway, it slid into Unit 3 with an unknown portion of Unit 2 striking the passenger side door area of
Unit 3 causing moderate damage.
Unit 2 towed by Gene Meyer with extensive damage to all sides, including the roof. All 4 occupants
of Unit 2 were uninjured but treated by Renton AID as a precaution. No injuries reported from either
of the other involved parties.
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 08-15-23 08:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 8/16/2023 9:04:09 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 4:30 PM TIME POLICE ARRIVED 4:32 PM
PART I PAGE IT]OF
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED89740
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9338
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MELL KONGKEAR B
(LAST FIRST,
ADDRESS&PHONE# D O.B.
2066368186 SEX U MMDDYYYY 04 - 25 - 1998
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) HUBBARD MELINDA J
ADDRESS&PHONE# O B
2063542885 SEx' U 4oO v O6 _ 09 _ 1962
PASSENGER []WITNESS POS. USE CLASS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
NAME
(LAST FIRST,MIDDLE INITIAL) LASMAN BARBARA A
ADDRESS&PHONE# 2065517035 SEX D D.O.B. 03 28 _ 1957
MMDDYYYY -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ POS. USE CLASS
NARRATIVE'
Unit 1 was in the center turn lane facing westbound on SW Grady Way intending to turn left onto
southbound Maple AVE SW. Unit 2 was traveling eastbound in the far right (#1) lane of three
eastbound lanes of SW Grady Way approaching Maple AVE SW. Unit 3 was stopped in traffic in the
middle eastbound lane (#2) of SW Grady Way just adjacent or just east of Maple AVE SW. The left
and center lanes of eastbound SW Grady Way (#3 and #2) had traffic stopped backed up from a
traffic signal to the east and backed up west of Maple AVE SW. The lane Unit 2 was traveling in (#1)
was a right turn only lane eventually on to SR-167 and had free flowing traffic. Motorists in the
stopped lanes #3 and #2 stopped short and made room for Unit 1 to turn left onto southbound Maple
AVE SW. Driver 1 stated they were signaling him to go and he did not realize there was a third lane
(#1), which Unit 2 was approaching in, so he began his turn. Unit 1 initiated this left turn and
accelerated towards the south just as Unit 2 lawfully entered the intersection proceeding eastbound
with the right of way. The front end of Unit 1 struck the middle/rear of Unit 2 causing moderate/heavy
damage. The force of this collision spun Unit 2 counter-clockwise with the rear end rotating up and
on to the sidewalk. These forces rolled Unit 2 over on to the passenger side and then on to the roof
with it still rotating counter-clockwise in the roadway. Before Unit 2 came to rest on its roof in the
roadway, it slid into Unit 3 with an unknown portion of Unit 2 striking the passenger side door area of
Unit 3 causing moderate damage.
Unit 2 towed by Gene Meyer with extensive damage to all sides, including the roof. All 4 occupants
of Unit 2 were uninjured but treated by Renton AID as a precaution. No injuries reported from either
of the other involved parties.
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 08-15-23 08:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 8/16/2023 9:04:09 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 4:30 PM TIME POLICE ARRIVED 4:32 PM
PART I PAGE IT]OF
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED89740
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9338
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) XUAN-TRANG TRAN-THIEN
(LAST FIRST,
ADDRESS&PHONE#
2067697569 SEX i U MMDDYYYY 02 - 18 - 1974
---------------------------
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# DOB
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 was in the center turn lane facing westbound on SW Grady Way intending to turn left onto
southbound Maple AVE SW. Unit 2 was traveling eastbound in the far right (#1) lane of three
eastbound lanes of SW Grady Way approaching Maple AVE SW. Unit 3 was stopped in traffic in the
middle eastbound lane (#2) of SW Grady Way just adjacent or just east of Maple AVE SW. The left
and center lanes of eastbound SW Grady Way (#3 and #2) had traffic stopped backed up from a
traffic signal to the east and backed up west of Maple AVE SW. The lane Unit 2 was traveling in (#1)
was a right turn only lane eventually on to SR-167 and had free flowing traffic. Motorists in the
stopped lanes #3 and #2 stopped short and made room for Unit 1 to turn left onto southbound Maple
AVE SW. Driver 1 stated they were signaling him to go and he did not realize there was a third lane
(#1), which Unit 2 was approaching in, so he began his turn. Unit 1 initiated this left turn and
accelerated towards the south just as Unit 2 lawfully entered the intersection proceeding eastbound
with the right of way. The front end of Unit 1 struck the middle/rear of Unit 2 causing moderate/heavy
damage. The force of this collision spun Unit 2 counter-clockwise with the rear end rotating up and
on to the sidewalk. These forces rolled Unit 2 over on to the passenger side and then on to the roof
with it still rotating counter-clockwise in the roadway. Before Unit 2 came to rest on its roof in the
roadway, it slid into Unit 3 with an unknown portion of Unit 2 striking the passenger side door area of
Unit 3 causing moderate damage.
Unit 2 towed by Gene Meyer with extensive damage to all sides, including the roof. All 4 occupants
of Unit 2 were uninjured but treated by Renton AID as a precaution. No injuries reported from either
of the other involved parties.
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 08-15-23 08:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
CO.JOHNSON 0505 8/16/2023 9:04:09 AM
BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 4:30 PM TIME POLICE ARRIVED 4:32 PM
PART I PAGE 4]OF
SUPPLEMENTAL REPORT NO. ED89740
r`I POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-9338
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER
ADDRESS `
CITY ST' ZIP'
4 ❑ NAME # PLACARD: :❑
GI NAME 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:2064463847
OF 7 29
LAST NAME AHMED FIRST NAME AHMED MIDDLE' Y
INITIAL
] r:j
STREET 30
NEW AnDRFSP 535 BURNETT AVE S APT 1 CITY RENTON ST WA ZIP 980572578
6
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:]
YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv', 06 - 15 - 1961
7
ON DUTYl STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE CFP3232 TAr Wq VIN# 1HGCV1F45KA013503
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2019 MAKE HOND MODELACCORD STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1Ci P FROM TO
DAMAGE YES NO YES NO
33
SHADE IN DAMAGED AREA
REGISTERED OWNER INFOAHMED AHMED 1370037TH AVE S APT 46 TUKWILAWA98168 J 9
12 z 4
FROM TO
LIABILITY INSURANCE❑ INSURANCE CO STATE FARM 149 0484-A30.47C
IN EFFECT &POLICY# 1 4 TCSP S.
LEGA LE 34
13 ❑ LEGALLY YES NO❑ CITATION# CHARGE 0 0Q Y)M
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 IGNITtGN 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 ICLASS
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 3 4 4 AREA F 43
z
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.
K.LANE 08-15-23 08:46 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 811612023 PAGE F OF 6
3000-345-013(R 11118)
REPORT NO. ED89740 CASE# ' 23-9338 DATE AND TIME 08/14/23 16:28
OF COLLISION
i
***IT TO SCALE*** 1
MAPLE AV 'WSJ
i
PAGE 6 OF s