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Home My WebLink About23-12631 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c COLLISION REP FIT 1591971 CASE 23-12631 z INTERSTATE ❑ CITY STREET ❑ FIRE ❑ RESULTED 1 STOLEN STATE ROUTE OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OS STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cawsloN 11 - 1-- 2023 1844 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 1800 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ MILE N�,❑ FEET e S ❑ E e CEDAR RIVER PARK DR 0 3 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES ✓NO D:2064680410 0 11 30 6� LAST NAME WILBURN FIRSTNAME APRIL MIDDLE 1 1 1 2 31 INITIAL STREET ❑, 125 SW 112TH ST,UNIT 603 CITY SEATTLE ST WA ZIP 98146 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYES NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE OF INJURIES z❑ USE CLASS COMPLAINT OF PAIN RIBS/CHEST/HEAD 3 10❑ PI ATE 14 CFV5622 STATE WA V N#' 4T1 CE30P68U763282 TRAILER STATE TRAILER STATE 11 4 0 PLATE# PLATE# ROM ro TRLR. TRLR 5 3 33 12 4 0 VIN#' VIN# :: FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TAW/g[ GOVT.VEHICLE 34 13 4 2008 TOYT CAMRY P4 D AMA G 7 3 E YES NO TOWING YES❑ No✓ REGISTERED OWNER INFO BURNICE THOMPSON 711845TH AVE S SEATTLE WA 98146 D:2064680410 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 ❑ ❑ INSURANCE CO 2 3 4 14 LIABILITY INSURANCE UNKNOWN IN EFFECT &POLICY# 9TOP VEH" CHARGE 36 LEGALLY YES❑NO❑ CITATION# 3A0776120 FAIL YIELD PRIVATE RD MOTOR 1 o aorrom 15❑ STANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062405958 16 a LAST NAME LINEBARGER FIRST NAME KIMBERLY MIDDLE J INITIAL 17 STREET NEW ADDREsS❑' 21241 103RD CT SE, CITY KENT ST WA ZIP 98031 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NOF,/ 19 LDI IVER # STATE WA ]SEX IF M D.O.B. 08 _ 31 1977 39 20❑ ON DUTY STATUS I AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ILICENSE 21❑ PLA E# BXZ5778 TATE 41 WA VIN# 1C4RJFLG7HC842148 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. TOWED BY Gov HI 44 VEH YEAR 2017 MAKE JEEP MODEL GRAND STYLE P4 DAMAGE TOWED✓ NOO BLIN BANKERS TOWING YES No 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSU&PORGY#E CO NATIONWIDE 7246JO2394IN STOP 5 VE""LE ❑ Nu,J CITATION# CHARGE io BOTTOM LEGALLY YES 25 ' e 7NELSON NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 12421 WA0171300 PART A PAGE 01 OF 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE21043 COLLISION REPORT III III III III III 111 1591972 CASE# 23-12631 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) ANDERSON ZAYA/RE L (I.P.ST FIRST, ADDRESS&PHONE# 125 SW 112TH ST,UNIT 603 SEATTlE WA 98146 2064680410 SEX M MMDOYyry - SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# j 1 SOS. 3 AIRBAG 4 RESTR, 4 EJECT 1 USE 2 CLASS 7 HEAD/NECKC TPAIN NAME '(LASTr FIRS' MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX' MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&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. D.NELSON 11-02-23 09:45 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 1 1111912023 3:36:15 AM BADGE OR ID# ! 12421 ORI#' WA0171300 TIME POLICE DISPATCHED 6:48 PM TIME POLICE ARRIVED',6:49 PM PART I PAGE IT]OF 6� REPORT NO. EE21043 CASE# 23-12631 OF COLLISION 11/02/23 18:44 OF CbLLI510N NARRATIVE 23-12631 INJ ACC On 11/2/2023 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the City of Renton. I was dispatched to a report of a two-motor vehicle collision near Maple Valley Highway and 1405 Renton/King/WA. While enroute I was flagged down by a witness who advised there was a three-vehicle collision further own Maple Valley Highway involving a child. I immediately diverted to that call. I located the collision just east of Cedar River Park Dr on Maple Valley Highway. I checked with Vehicle 1, a silver 2008 Toyota Camry Solara (WA/CFV5622) driven by April I Wilburn (DOB: 5/2/1995). April advised she was partially trapped in the vehicle and had neck and rib pain. The curtain airbags were deployed in the vehicle and there was a large amount of damage to the driver side of the vehicle. Aprils son, Zyaine L Anderson (DOB: 7/28/2014) had been in the front passenger seat and had pain to his head and chest. April said that she was trying to turn east onto Maple Valley Highway from Cedar River Park Dr. She said that she had a red light and pulled out onto Maple Valley when she was struck by Vehicle 2, a 2017 Jeep Grand Cherokee (WA/BXZ5778), who was driving east in Maple Valley Highway. The Jeep, driven by Kimberly J Linebarger (DOB: 8/31/1977), advised she was in the inside lane when she struck Vehicle 1. The Jeep had damage to the front. Kimberly was uninjured. Vehicle 3, a gray 2016 Buick Verona (WA/CFU8831) driven by Isaiah O Sutton (DOB: 2/10/1993) and Vehicle 4, a silver 2012 Kia Optima (WA/AHV7971) driven by Marcellus N White (DOB: 1/9/1976) were driving west on Maple Valley and stopped for the collision on the inside lane. While stopped for traffic, Vehicle 4 was struck by Vehicle 5, a black 2006 Ford F150 (WA/C58147V) driven by Efrain A Bernal (DOB: 11/11/1991). Vehicle 5 rear-ended Vehicle 4 pushing it into Vehicle 3. All involved drivers and passengers were evaluated by RRFA personnel and cleared at the scene. Bankers Towing removed all vehicle from the scene. I completed Sector Citation #3A0776120 for RCW 46.61.205 Failure to Yield Entering Highway from a Private Road or Driveway for April. This citation should be mailed to her. Nothing further. PAGE 3 OF 6 SUPPLEMENTAL REPORT NO. EE21043 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-12631 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 1 8 28 CARRIER NAME 3 CARRIER L ADDRESS `❑ CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER �I YES✓ NO D:2067550180 OF 7 29 LAST NAME SUTTON FIRST NAME ISAIAH MIDDLE O INITIAL 0 7 30 STREET NEW AnnRFsP 14300 SE 171 ST WAY,APT T5 CITY RENTON ST WA ZIP 98058 6 ❑ 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO✓ zERLOCK YES❑NO❑✓ YEs N ✓ DRIVER'S LICENSE STATE I WA SEX M MMDDYYv', 02 - 10 - 1993 7 ❑ HELMET INJURY NATURE OF INJURIES ON DUTY STATUS AIRBAG 2 RESTR. 1 EJECT 1 USE 2 CLASS 7 HEAD/NECK PAIN 8 ❑ 1 1 2 32 LICENSE CFU8831 TAT INA VIN# 1G4PW5SK0G4142288 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 TRLR TRLR 91 VIN.It VIN.#. 11 4 VEH.YEAR2016 MAKE BUIC MODEL VERANO STYLE P4 VEHICLE TOWS ET SABLI T�f°E TO WING GnVT VFHII' FROM TO DAMAGE YES✓NO YES NO ✓ REGISTERED OWNER INFO OWNED BY DRIVER J 9 33 12 4 O SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE[] INSURANCE CO NONE ) 91"OI' 9 9 IN EFFECT &POLICY# VEHICLE m 34 13 ❑ LEGALLY YES NO❑ CITATION# CHARGE 0 OTTOM STANDING S 7 DAMAGETHRESHOLD MET PHONE ❑ 35 14 UNIT# 4 MdT{7R ❑✓ PEDAG ❑ PEDESTRIAN ❑ PROPERTY ❑ YES NO VEHICLE : CYCLE OWNER ✓ D:2063275977 15 � WHITE MARCEttUS MIDDLE N ❑ 36 LAST NAME FIRST NAME INITIAL 2 STREET 16 ❑ ❑; 29218 SE 200TH ST CITY MAPLE VALLEY ST WA ZIP 98038 NEn+AnnRESS CDL IGNITION RE'dUiREE7 IGNITION PRESENT MEDICAL TANSPORTED 17 ❑ INTERLOCK YES NO✓ INTERLOCK YEs NO✓ YEs NO;./ ❑ DRIVER'S D.O.B 4 37 STATE WA SEX M 18 ❑ LICENSE# MMDDYYY 01 - 09 - 1976 ON DUTY❑ STATUS' AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 38 USE CLASS HEAD/NECK PAIN 19 ❑ ❑ 39PLATE# AHV7971 W v!N# KNAGM4A72C5289229 20 ❑ TRAILER' STATE TRAILER ST 40 PLATE#< PLATE# ATE 21 ❑ ❑ 41 TRLR TRLR ViN# YIN#i 42 22 VEH.YEA MAKEMAKE KIA MODEL OPTIMA STYLE P4 VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE 1 DAMAGE YES ✓NO BANKERS TOWING YES NO ✓ 23 ❑ REGISTERED OWNER INFO OWNED BY DRIVER SHADE IN DAMAGED AREA 43 LIABILITY N EFFECTNSURANCE INSURANCE CO F/RST NATIONAL H2243209 ❑ 44 ❑ ❑ &POLICY#24 LE LE ALLYLE YESZ NO❑ CITATION# 41�no .STANDING y STANDING a 7 y;g 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. D.NELSON 11-02-23 09:45 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OI BADGE 12421 O#I',WA0171300 APPROVED 11/19/202 PAGE F OF❑ 3000-345-013(R 11118) SUPPLEMENTAL REPORT NO. EE21043 r`) POLICE TRAFFIC 1 5 3 27 COLLISION REPORT CASE# 23-12631 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 5 VEHICLE t_"J � PEDESTRIAN YEs� NO 0 1 29 LAST NAME ARIAS BERNAL FIRST NAME EFRAIN MIDDLE INITIAL STREET 30 NEW AnDRFSP' 14217 1421VD AVE SE CITY RENTON ST WA ZIP 98059 6 ❑ 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO zERLOCK YES❑N0� YEs N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 11 - 11 - 1991 7 ON DUTY� STATUS AIRBAG' $ RESTR. Q EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES USE cLASS 8 ❑ 1 32 LICENSE I C58147V [TAT WA VIN# 1FTRX14516FA00142 PLATE# 9 TRAILER TRAILER PLATE If STATE PLATE If STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 4 0 VEH.YEAR2006 MAKE FORD MODELFI50 STYLE PK VEHICLE TOWS E T SABLI a 'TOWING Gf1VT VFHII' P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO OWNED BY DRIVER 3 ] 33 SHADE IN DAMAGED AREA � 4 12 FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 91C7I' VEHICLE 10 BDrroM 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE ❑ STANDING dRD PROPERTY NOHRHOLD MET 7 6 ❑ 35 VEHICLE CYCLE OWNER YESG PHONE 14 UNITr 15 LAST NAME FIRST NAME MIDDLE 36 INITIAL ❑ STREET"[-] 16 NEW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE If STATE 21 ❑ ❑ 41 TRLR TRLR 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 AREA 43 3 4 71 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. D.NELSON 11-02-23 09:45 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12421 O#I',WA0171300 APPROVED 11/19/202 PAGE F51 OF 6 3000-345-013(R 11118) REPORT NO. EE21043 CASE# ' 23-12631 DATE AND TIME 11/02/23 18:44 OF COLLISION y fi l i PAGE 6 OF 6