HomeMy WebLinkAbout23-11077 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-11077 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' TRAFFIC SIGNAL POLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 09 - 1-- 2023 0800 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
EASTVALLEYRD ST e✓
MILEPOST 4100 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ V\e SW41ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:9717017243 0 81
30
LAST NAME LAVENDER-OLSEN FIRSTNAME KIEREN MIDDLE F1
6 INITIAL 1 2 31
STREET ❑ 21907 42ND AVE S UNIT 204 CITY KENT ST WA 2jp, 980322375 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YE. No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E CUSS 1 NATURE OF INJURIES z❑
3
10[1P1 LICENSETE 14 YHH991 sTAT OR v N# 3VWRA29MOXM053971
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 1999 MAKE VOLK MODEL JETTA STYLE VEHICLE TOWED 0 TO
ffBLIN TSIgWgYMEYERS VEHICLE
9 9 34
13❑ DAMAGE LJI (�ciV6
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCE CO GEICO 6138211518 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLYYES❑NO❑ CITATION# 3A0387756 INATTENTIVE DRIVING <1�3
orrom
15❑ STANDING 7 6
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO V D:2532855320
16 a
LAST NAME CIANCA MUNOZ FIRST NAME CRISTINA MIDDLE N
INITIAL
17❑ STREET ❑', 1001 1ST AVE N APT B108 CITY KENT ST WA ZIP 980325018 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES t l NO❑
19 LICENSE# STATE WA SEX F M D.C.B. 03 _ 13 _ 1960 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I BXH2O90 TATE WA VIN# 1N46L46V1KC219864
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE NISS MODEL ALTIMA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CRISTINA CIANCA 10011STAVE N APT B108 KENT WA 98032 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 4580590 C16479IN I GD
LEGAL
25
LY YES Nu
❑ s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE02916
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11077
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 09/27/23 1 responded to a 2-vehicle non-injury/blocking collision at SW 41st and East Valley Rd.
I contacted the driver of unit 2 who told me they were stopped for a traffic signal in the #2 lane of
northbound East Valley Rd at SW 41st when she was rear-ended by unit 1. The driver did complain of
neck pain and was treated on scene by Renton Fire. The vehicle sustained rear bumper damage but
still drivable.
I contacted the driver of unit 1, identified as Kieren Lavender-Olson (dob 04-15-96) via his WA DL.
Lavender-Olson says he was traveling northbound in the #2 lane of East Valley Rd. He says his
Monster drinks fell to the floor and he looked down to take sure it did not roll under his foot. When he
looked back up he realized unit 2 was stopping but he was too close and hit her from behind. He was
not injured but front-end damage required a tow by Gene Meyers.
But not for the action of UNIT 1 DRIVER the result would not have happened.
I cited Lavender-Olson via SECTOR under RMC 10.12.25-Inattentive Driving
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 09-27-23 09:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 912712023 10:19:50 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 8:00 AM TIME POLICE ARRIVED',8:15 AM
PART I PAGE IT]OF 3�
REPORT NO. EE02916 CASE# 23-11077 DATE AND TIME 09/27/23 08:00
OF COLLISION
N
i
SW 41 ST
East Valley Road
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