HomeMy WebLinkAbout23-14437 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-14437 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 12 - 1-- 2023 1327 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD ST BLOCK e✓ 900 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a MAIN AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067959718 0 11
30
6� LAST NAME THAMERT FIRSTNAME HAZEL MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 7856 S 113TH ST CITY SEATTLE ST WA ZIP, 981783238 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� CES1602 sTATI WAvIN# 3VWSF71K26M662472
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 1 2006 VOLK JETTA DAMAGE vesNo ves❑ No
REGISTERED OWNER INFO RICHARD THAMERT 7856 S 113TH ST SEATTLE WA 98178 D:2067959718 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 4070392149 4
IN EFFECT &POLICY# 9TOP
VE—L' 1 5 36
LEGALLv YEs❑NO❑ CITATION# CHARGE
10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067128669
16 a
LAST NAME DUGGINS FIRST NAME MIEKO MIDDLE M
INITIAL
17 STREET I❑ s❑' 2220 O ST NE APT B CITY' AUBURN ST WA ZIP 980022953 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19[—] LDI IVERI # STATE WA ]SEX IF M D.C.B. 12 _ 02 _ 1994 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CEZ4604 TATE WA VIN1i KNALN4D74F5177656 41
1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE KIA MODEL CADENZ STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MIEKODUGGINS22200STNEAPTBAUBURNWA98002 D:2067128669 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ &POINSURGY#E CO DAIRYLAND 11408097908IN 1UQ,
VEHICLE ❑ ,.II CITATION# CHARGELEGALLY YES N25
7PTAGNE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
12575 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE32798
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14437
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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
P.LANTAGNE 12-20-23 09:11 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 12/21/2023 6:56:55 AM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED 2:14 PM TIME POLICE ARRIVED',2:19 PM
PART I PAGE IT]OF 4�
REPORT NO. EE32798 CASE# 23-14437 OF COLLISION
12/16/23 13:27
OF CbLLI510N
NARRATIVE
23-14437
On 12/16/2023 at approximately 1327 hours, I, Officer Lantagne, responded to a blocking, non-injury
collision which occurred on S 3rd ST at the intersection of Main AVE S, which is located in the City of
Renton, County of King, and the State of Washington. I responded in my fully marked police vehicle,
wearing my patrol uniform.
I arrived on scene and observed Unit#1, a 2006 Volkswagen Jetta with license plates CES1602
issued out of Washington State, and Unit#2, a 2015 Kia Cadenza with license plates CEZ4604. I was
advised there were no injuries.
I contacted the driver of Unit#1, Hazel A. Thamert (DOB 09/06/2003), who told me the following:
Thamert was driving eastbound on S 3rd ST in the right lane. Thamert merged into the left lane to get
around a stopped vehicle but needed to make a right turn onto Main AVE S. Thamert merged right
back into the right lane and the passenger side of her vehicle was struck by Unit#2.
1 contacted the driver of Unit#2, Mieko M. Duggins (DOB 12/02/1994), who told me the following:
Duggins was driving eastbound on S 3rd ST. As Duggins approached the intersection of Main AVE S,
Unit#1 merged into the right lane to make a right turn onto Main AVE S. Unit#1 struck the front of
Duggins' vehicle.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had significant crumple damage to the passenger side of
the vehicle on both doors. Unit#2 had significant damage to the left front bumper and driver's side
front fender which was pushed into the tire.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Duggins and Thamert.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 0853 hours on 12/20/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. EE32798 CASE# ' 23-14437 DATE AND TIME 12/16/23 13:27
OF COLLISION
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Case #23-14437'
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