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Home My WebLink About23-9410 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 3 27c COLLISION REP FIT 1591971 CASE 23-9410 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 04 STRUCK' FENCE 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 1144 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 105TH PL SE BLOCK NO. e✓ 17700 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:2536510848 1 4 30 6� LAST NAME TRIPLETT FIRSTNAME GENE MIDDLE W 1 1 2 31 INITIAL STREET ❑, 17735 105TH PL SE APT C103 CITY RENTON ST WA Zjp, 98055 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 H USEET ICNLJAURY 0 NATURE OF INJURIES 2❑ 3 10❑ PI ATE 14 C73829U JBTATIJ WA u N# 1 FTFX1 EF9FF842605 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM ro TRLR. TRLR 5 1 33 12 0 0 VIN#' VIN# FROM 34 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 2015 FORD F150 PK DAMAGE YES NOBS YES❑ No✓ 13❑ REGISTERED OWNER INFO GENETRIPPLETT17735105THPLSE APT C103RENTONWA98055 D:2536510848 VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 4 14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 IN EFFECT &POLICY# 9TOP VENICLE CHARGE 5 36 LEGALLv YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STAIN.D" 6 UNIT a2 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES ❑ DYES✓ NO OLD MET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE 17 INITIAL STREET CITY RENTON ST ZIP 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIICENS# STATE SEX U MMDDYY —�_ 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑ 21❑ LICENSE I C00781H TAre WA VIN# 1FDXW46F4YEC37519 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2000 MAKE FORD MODEL F450 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO PINNACLE NORTHWEST LANDSC LLC 18325214TH AVE NE WOODINVILLE WA 98077 D:4255411347 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO ICal vE""LE ❑ ,J� CITATION# CHARGE LEGALLY YES N J 25 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. ED97756 COLLISION REPORT III III III III III 111 1591972 CASE# 23-9410 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST 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' On 081623 1 responded to a 2-vehicle injury collision at 17735 105TH PI SE. Upon arrival I observed the driver of unit 1 pinned on his driver side against a tree and about 6 feet of wooden fence knocked down on the front end of the vehicle. I contacted the driver of unit 1 who would become known to me as Gene Triplett (born 05/21/49). He looked disoriented but was conscience. I requested Renton Fire to check on his medical needs and to assist with extracting him from the vehicle. Minutes later, fire arrived, and I was able to speak with one of the witnesses who is also the owner of unit 2 and 3 (pick-up w/trailer). Per the witness, his truck and trailer were unoccupied and parked on the property (Westview Village Apts) facing east (towards the entrance/exit to the property. He says while exiting the property, Triplett drove his truck into his and then continued off the property and exited south onto 105th PI Se. Witness moved his truck and trailer from that location and parked it along the west side of 105th PI Se (facing southbound). Moments later, Triplett returned, now northbound on 105th. Triplett collided again with the witness's unoccupied truck and trailer, lost his front driver-side wheel and collided with a wooden fence at the entrance to the property (Westview Village). The driver of unit 1, Triplett was taken to Valley Medical Hospital. Renton Fire is familiar with Triplett due to several contacts because of his health issues. His health issues were confirmed by Triplett's wife, who was at the scene shortly after the collision. Triplett and his wife reside at Westview Village. But not for the action of UNIT 1 DRIVER the result would not have happened. No citations were issued to Triplett. 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 08-22-23 07:33 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 911112023 10:26:25 AM BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 11:44 AM TIME POLICE ARRIVED 11:51 AM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. ED97756 r`I POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-9410 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GINAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_"J � PEDESTRIAN YES� NO 1 4 29 LAST NAME : UNKNOWN FIRST NAME MIDDLE INITIAL STREET 30 NFW AnnRFSP' CITY PUYALLUP ST ZIP 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No INTERLOCK YESE]NaE YEs N DRIVER'S STATE I SEX U M��DVSYv' -� 2 LICENSE 7 ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 1 HELMET 9 INJURY 0 NATURE OF INJURIES F� USE CLASS 8 ❑ 1 32 LICENSE 65322Ay TAr WA VIN# 184BU1012GCO19541 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLI anvi vEH1G P FROM TO 2016 EAGL UTILITY UT THE DAMAGE YES�NO YES NO REGISTERED OWNER INFOMARK HELP 2128 S MERIDIAN APT D306 PUYALLUP WA 983717545 D:2537496286 m 33 12 � SHADE IN DAMAGED AREA 7GQl j4 FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# t VEHICLE 34 ❑ ❑ CITATION# CHARGE 13 LEG LEY YES NO STANDING 4 MOTOR � PEDAG � � PROPERTY I ' DAMAGE THRESHOLD MET PHONE 35 14 UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO D:4255411347 15 ❑ PLACE WESTVIEW VILLAGE PL MIDDLE' ❑ 36 LAST NAME FIRST NAME INITIAL 16 ❑ STREET ❑! 17735 105TH PKE SE CITY! RENTON ST' WA ZIP 98055 NFW AnnRFS.9 CDL IGNITION REQUIRED IGNITtGN PRESENT MEDICALTANSPORTED 17 ❑ INTERLOCK YES NO INTERLOCK YEs N. rEs NO ❑ DRIVER'S STATE SEX U D.O.B 5 37 18 ❑ LICENSE# MMDDYYY - ON DUTY STATUS AIRBAG RESTR,I EJECT I HELMET INJURY NATURE OF INJURIES ❑ 38 USE CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ [441 TRLR TRLR 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 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 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. J.MITCHELL 08-22-23 07:33 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 10377 O#I',WA0171300 JACOBS 91,1/2023 PAGE F OF 4 3000-345-013(R 11118) REPORT NCV ED97756 CASE It ' 23-9410 DATE AND TIME 08/16/23 11:44 OF COLLISION NOT TO SCALE nrs b. -[J co m PAGE 4 OF 4