HomeMy WebLinkAbout23-13490 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-13490 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 RESERVATION STRUCK
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 11 - 1-- 2023 1501 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e S 3RD PL
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2064098033 0 11
30
6� LAST NAME MEDDAUGH FIRSTNAME JORDAN MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 605 POINT BROWN AVE NW 15 CITY OCEAN SHORES ST WA ZIP, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8 LRIIVER # STATE WA SEX'M MI 09 1- 18 - 2003 2 32
CENS [NATURE OF INJURIE
9 ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 EJECT 1 H U EET 6 CLASS RIGHT LEG PAINS 2❑
3
10❑ Pi ATE 14 CKK3663 STATE WA u N# 1 N4BA41 E57C829331
- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 1 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 2 2007 NISS MAXIMA SO DAMAGE vE5 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI V INSURANCE INSURANCE CO PROGRESSIVE 974488210 4
IN EFFECT &POLICY# TOPVE"'CLE CHARGE 36
LABILLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES NO ,/ D:2062713646
16 a
LAST NAME ACKERMAN FIRST NAME LOUANNA MIDDLE M
INITIAL
17 STREET❑ NEW ADOREss❑' 11415 127TH ST E 186 CITY PUYALLUP ST WA ZIP 98374 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK vEs It I NOF YES
t l NOF,/
19 RRS LDI IVE STATE WA ]SEX IF M .O.B. O6 _ 15 _ 1954 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CAK3047 TATE 41
WA VIN1i 3MVDMBEM8LM128807 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
Gov HI
VEH YEAR 2020 MAKE IlggZp MODEL CX-30 STYLE 4H —FEHICLE
TOWED NOO✓ BLIN TOWED By 44
fj
YES
NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO 1GD
VEHICLE ❑ C[:] CITATION# CHARGE
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE26002
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13490
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.
STEVEN FAJARILLO 11-23-23 04:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 12/3/2023 12:17:27 PM
BADGE OR ID# ( 12847 OR]# WA0171300 TIME POLICE DISPATCHED; 3:02 Pry] TIME POLICE ARRIVED',3:08 PM
FART I PAGE IT]OF 4�
REPORT NO. EE26002 CASE# 23-13490 OF COLLISION
11/23/23 15:01
OF CbLLI510N
NARRATIVE
23-13490
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 11-23-2023 1 was working as a police officer in the city of Renton. At approximately 1502 hours I
was dispatched to the report of a motor vehicle collision at 300 Rainier Ave S, City of Renton, County
of King, WA. This incident was captured on my department issued Axon body camera.
According to the notes in the call, there was a two-motor vehicle collision. There were no injuries and
both parties were off the roadway.
I arrived on scene and contacted the reporting party and driver of Vehicle 1, Jordan D Meddaugh
(DOB:09-18-2003). Vehicle 1 was identified as a tan 2007 Nissan Maxima (DOB:CKK3663). Jordan
was travelling north at the 300 block of Rainier Ave S. He entered the intersection at S 3rd PI and
noticed there was traffic. Vehicle 2 abruptly stopped in the middle of the intersection. Jordan was
unable to brake in time. Vehicle 1's front bumper collided with Vehicle 2's rear bumper.
I spoke with the driver of Vehicle 2, Louanna M Ackerman (DOB:06-15-1954). Vehicle 2 was
identified as a gray 2020 Mazda CX-30 (WA/CAK3047). Louanna told the same story as Jordan.
They were both evaluated by the fire department and cleared medically. Vehicle 2 had non-reportable
damage and Louanna was able to drive. I provided both involved parties with a case number. Vehicle
1 was towed privately. I photographed the damage to each vehicle and uploaded the pictures to
Evidence.com.
There was nothing criminal. Vehicle 1 failed to stop in time for stopped traffic, subsequently colliding
with Vehicle 2.
There is no further information available at this time.
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 S. Fajarillo #12847 on 11/23/2023 @ 1612 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EE26002 CASE# ' 23-13490 DATE AND TIME 11/23/23 15:01
OF COLLISION
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