HomeMy WebLinkAbout23-13201 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13201 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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# ❑
cowsloN 11 - 1-- 2023 1345 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 13300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 600 00 FMILES EET e S ❑ E e SE 131ST ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4255296703 0 6 30
6� LAST NAME TARAFDAR FIRSTNAME MEHR MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 925 243RD PL SE CITY SAMMAMISH ST WA ZIP 980758142 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 EJECT 1 H U SE CLASS 7 STOMACHNJURIEs z❑
3
10 P1 ATE 14 AVT7958 sTAT WAu N# 2HKRM4H79FH641597
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE ] $ 34
13 3 2015 HOND CR-V DAMAGE YES NO MEYER YES❑ NO✓
REGISTERED OWNER INFO S..TARAFDAR 925 243RD PL SE SAMMAMISH WA 98075 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO ST FARM 422 9601 F1147A 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3A0681734 INATTENTIVE DRIVING )o eorrom
15❑ STANDING 7 6
MOTOR PEDAL- '.PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067650128
16 a
LAST NAME THAI FIRST NAME YEN MIDDLE B
INITIAL
17❑ STREET ❑', 1332 W PIONEER CITY PUYALLUP ST WA ZIP 983715280 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 D IVEW #
ON DUTY STATUS AIRBAG,3 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES 40
USE CLASS FACE
21❑ LICENSE I CEC4550 TATE WA VIN1i 2HKRW2H93HH617119
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE HOND MODEL CR-V STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO SON NGO 1332 W PIONEER PUYALLUP WA 98371 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IU
9TOP
VE""LE ❑ ,J� CITATION# CHARGE o BOTTOMLEGALLYYES N`L J25 '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE22363
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13201
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.
M.LEVERTON 11-15-23 04:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1112212023 10:34:51 AM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED 1:45 PM TIME POLICE ARRIVED 1:50 PM
PART I PAGE IT]OF 4�
REPORT NO. EE22363 CASE# 23-13201 OF COLLISION
11/15/23 13:45
OF CbLLI510N
NARRATIVE
slv/2 suv lane 1 slowing blu/1 suv rear
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash with injury near about
the 13500 block of Maple Valley Hwy.
When I arrived I located a long set of tire marks leading to 2 SUVs blocking lane 1 eastbound
(southbound).
I contacted unit 1 ID'd by her picture WADL who told me that she was following unit 2. She said she
had something on her hand, possibly some fuzz and put her hand out the window. Not recognizing
unit 2 along with other traffic was slowing she continued until she crashed into the back of unit 2. She
did not complain of injury, only a stomach ache and damages required a tow truck. I overheard unit 1
driver tell an onscene Sgt that she has only had her license barley 3 weeks.
Renton Fire was treating unit 2 driver, who had been standing outside her car and then collapsed.
She was transported to VMC-ER for additional treatment. Unit 2 did not speak English and did not
provide any additional information ref the crash. Damages required a tow truck. The RO of unit 2 is
currently deployed in Iraq and requested we secure a pistol in his car. A search of the car only
revealed a holster and a suppressor, no firearm located.
I cited unit 1 driver ref RMC 10-12-25 Driver Inattention 2 car injury crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 11/15/2023
PAGE 3 OF 4
REPORT NO. EE22363 CASE# ' 23-13201 DATE AND TIME 11/15/23 13:45
OF COLLISION
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PAGE 4 OF 4