HomeMy WebLinkAbout23-14619 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 5 27c
COLLISION REP FIT 1591971
CASE 23-14619 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 1733 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY SE BLOCK NO. e✓ 15100
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 588 00 FMILES N EET e S ❑B E e MAPLE VALLEYHWY
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:4252478280 0 81
30
6� LAST NAME SEDGWICK FIRSTNAME ROBERTA MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 16055 SE 128TH ST CITY RENTON ST WA ZIP' 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED I IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z YES No�/
8❑ LRIIVER #
[ ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES z❑
USE CLASS C/O CHEST PAIN.DECLINED AID RESPONSE
3
10❑ PI ENS11 B39538$ STATE WA VIN#' JT4RN81A7R5198168
TRAILER STATE TRAILER STATE
11 4 0I PLATE# PLATE# FROM TO
rRLR. TRLR 5 1. 33
12 4 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR y GOVT.VEHICLE J 9 34
13 2 1994 TOYT PICKUP PK DAMAGE YES NO MEYERS YES❑ NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO FARMERS 186280740 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLYYES❑NO❑ CITATION# W23067379 INATTENTIVE DRIVING <1�3
orrom
15❑ NDING 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT ❑✓ ❑ PEDESTRIAN ❑ ❑ D:2532179588
VEHICLE CYCLE bWNFR YES�/ NO
16 a
LAST NAME FLORES FIRST NAME EULOGIO MIDDLE IL
INITIAL
17❑ NEW STREETREss❑' 18025 SE 272ND ST#J-204 CITY COVINGTON ST WA ZIP 98042 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES t l NOF,/
19 LDI IVERS STATE WA SEX M M D.C.B.
11 04 1971 39
20 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 WEB SET 2 NJAU SY 7 C/O BACK PAIN�DECLINED AID RESPONSE 40
LICENSE I ❑21❑ PLA E# CDL4890 [TAT WA VIN 1 41
2T3MWRFV7NW144915 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY GOV HI 44
VEH YEAR 2022 MAKE 7'Oy7- MODEL RA V4 STYLE $V DAMAGE TO WED NOO✓ BLIN YES
NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 817-640-275IN 1 9TOP
VE""LE CITATION# CHARGE
LEGAL
25 i o BOTTOM
LY YES Nu
❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE34924
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14619
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) FLORES GAILROSE P
(LAST FIRST,
ADDRESS&PHONE# D O.B.
18025 SE 272ND ST#J-204 COVINGTON WA 98042 2532179588 SEX F MMDDvyvv 03 - 28 - 1980
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑; 2 POS. 3 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) PASTRANA FLORES GABRIEL L
ADDRESS&PHONE# D O B
18025 SE 272ND ST#J-204 COVINGTON WA 98042 2532179588 SEX M MMDDvvvv 10 _ 19 _ 2006
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
LnsT FRST MIDDLE INITIAL) PASTRANA FLORES ALESSANDRA Y
AooREss&PHONE# 18025 SE 272ND ST#J MMDDYYYY
-204 COVINGTON WA 98042 2532179588 SEX F D.O•B. 09 _ 15 _ 2011
PASSENGER WITNESS UNIT# ! 2 SEAT 7 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 NJURY 1 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.
MATTHEW NUGENT 12-27-23 11:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/28/2023 7:07:09 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 5:36 PM TIME POLICE ARRIVED',5:43 PM
PART I PAGE IT]OF 4�
REPORT NO. EE34924 CASE# 23-14619 OF COLLISION
12/20/23 17:33
OF CbLLI510N
NARRATIVE
23-14619
On 12/20/2023 at approximately 1736 hours, I was dispatched to a blocking vehicle collision in the
15100 block of 140th Way SE (just south of Maple Valley Highway), within the City Limits of Renton,
County of King, State of Washington.
While en route, Dispatch advised that one of the involved vehicles was not drivable. Dispatch advised
that two vehicles were reported to be involved and were described as a silver Toyota pickup and a
grey Toyota RAV4.
Upon arrival, I contacted all involved parties and confirmed there were no complaints of injury
requiring immediate medical response at the time of report. I collected each involved party's
information and independent involvement leading up to the collision.
The driver of Unit#1 said she was traveling northbound in the 15100 block of 140th Way SE in lane 1
of 3. The driver of Unit#1 stated she was traveling directly behind Unit#2. The driver of Unit#1
stated she noticed Unit#2 was stopped or slowing for traffic and attempted to stop her vehicle in time
but that her brakes locked up. The driver of Unit#1 stated that her vehicle contacted the rear of Unit
#2 causing significant damage to the front of Unit#1.
The driver of Unit#2 said he and his three passengers (1 adult, 2 juveniles) were also traveling
northbound in the 15100 block of 140th Way SE in lane 1 of 3. The driver of Unit#2 stated that he
was approaching the traffic light-controlled intersection which was displaying a red light and had
come to a stop behind queued traffic. While Unit#2 was stopped for traffic, Unit#1 collided with the
rear of Unit#2 causing moderate damage to the rear of the vehicle.
Based on the above statements, I determined that the Driver of Unit#1 (Sedgwick) was the
predominant factor for the collision due to Inattention. Unit#2 had the right of way when it was struck
by Unit#1 from behind.
I issued Sedgwick a Written Warning for Inattentive Driving causing a collision.
Unit#1 had to be impounded due to extensive damage. Unit#2 was able to be driven away without
further incident. An exchange of information was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 12/27/2023 10:39 AM Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EE34924 CASE# ' 23-14619 DATE AND TIME 12/20/23 17:33
OF COLLISION
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PAGE 4 OF 4