HomeMy WebLinkAbout23-12845 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-12845 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 11 - 1-- 2023 1736 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S PUGET DR BLOCK NO. e✓ 2000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 15 00 FEET MILES ❑ S ❑ W e BENSON DR S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:9545152143 0 11
30
6� LAST NAME VANTERPOOL FIRSTNAME ALIKO MIDDLE A 1 1 2 31
INITIAL
STREET ❑✓ 11714 PACIFIC AVE S CITY PARKLAND ST WA ZIP 98444 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 4 EJECT 1 HELMETU E 2 'NJUR 5Y 1 NATURE OF INJURIES z❑
❑LICENSE CJH0426 STATE WA VIN# JM3KE4DY8F0503874 3
10 9❑ PI ATE 11
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2015 MAZE) CX-5 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO RIKA NORELUS4209 S 30TH STAPTA5 TACOMA WA 98409 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO eq�T3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP 5
VewcLE CHARGE 10 BOTTOM 36
LEGALLY YEs❑NO CITATION# 3AO733710,3AO733710 OP MOT VEH W/OUT INSURANCE,
15❑ STANDING 8 7 6
MOTOR PEDAL-:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:4257612520
16 a
LAST NAME PETERSON FIRST NAME KIMBERLEY MIDDLE A
INITIAL
17 NEW STREETR 7' 11626 SE 163RD ST CITY RENTON ST WA ZIP 980585360 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/
19 LDI IVER # STATE WA ]SEX IF M D.C.B. 05 _ 26 _ 1981 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# BHX8583 TATE WA VIN# 41
STDBT48A74S210215 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2004 MAKE TOYT MODEL SEQUOIA STYLE VEHICLE TOWED TO BLIN TOWEDeY GOV HI �44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO JASON PETERSON 11626 SE 163RD ST RENTONWA 98058 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 465-3775-B20-47AIN 1—e E ❑ ,J� CITATION# CHARGE UR
LGALYES N
25 7S/;S
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12225 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE23030
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12845
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
PM 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.
E.SIMS 11-08-23 01:24 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
G.BARFIELD 6476 1111612023 1:24:47 AM
BADGE OR ID# 12225 OR]# WA0171300 TIME POLICE DISPATCHED; 6:05 PM TIME POLICE ARRIVED',6:06 PM
PART I PAGE IT]OF 4�
REPORT NO. EE23030 CASE# 23-12845 OF COLLISION
11/07/23 17:36
OF CbLLI510N
NARRATIVE
Renton Case #23-12845
On 11/07/2023 at approximately 1805 hours, I was dispatched to the Seventy-Six Station, located at
2022 S Puget DR, in the City of Renton, King County, Washington, for a report of a non-injury, non-
blocking accident.
Upon arrival I identified Unit 1 as a blue 2015 Mazda CX-5, bearing WA license plate #CJH0426. Unit
1 sustained minor damage to the front right bumper.
I identified the driver of Unit 1 via his FLDL as Aliko Akeem Omaree Vanterpool (DOB 05/24/1988).
Vanterpool stated he was not injured, and I asked him what happened. Vanterpool told me he was
driving eastbound in the left lane of travel in the 2000 block of S Puget DR, when he tried to merge
into the right lane of travel and struck Unit 2. Vanterpool told me he did not see Unit 2 prior to hitting
her vehicle.
Vanterpool also told me the vehicle belonged to his girlfriend and he did not know where the
insurance card for the vehicle was. Vanterpool called his girlfriend and she was unable to find the
insurance card for the vehicle.
I identified Unit 2 as a gray 2004 Toyota Sequoia, bearing WA license plate #BHX8583. Unit 2
sustained minor damage to the front left side panel and front left headlight.
I identified the driver of Unit 2 via her WADL as Kimberley Ann Peterson (DOB 05/26/1981). Peterson
told me she was not injured, and I asked her to tell me what happened. Peterson told me she was
driving eastbound in the 2000 block of S Puget DR in the right lane when Unit 1 merged into her lane
and struck her vehicle.
I provided both parties with my business card with the case number on it and answered their
questions. Due to the damage of the vehicles being consistent with each driver's version of what
happened I determined that Vanterpool was the at fault party. I advised Vanterpool he would receive
a citation in the mail for Inattentive driving and for operating a motor vehicle without proof of
insurance.
I then cleared the scene. This ends my report.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by E. Sims on 11/07/2023 at 2241 hours, in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. EE23030 CASE# ' 23-12845 DATE AND TIME 11/07/23 17:36
OF COLLISION
. ,
NOT TO SCALE
PAGE 4 OF 4