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Home My WebLink About23-7092 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 23-7092 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 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 06 - 1-- 2023 1030 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ DUVALL AVE NE BLOCK NO. e✓ 1600 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e O 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2067551223 0 6 30 6� LAST NAME ANDERSON FIRSTNAME DREW MIDDLE A 1 2 31 INITIAL STREET ❑, 225 DUVALL AVE SE CITY RENTON ST WA Zjp, 980595069 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO I INTERLOCK YES NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9❑ Pi aT�S� BCK6484 sTArI WAvIN# JH4Ct96875CO29571 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. YRLR. 5 1 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR ZOOS MAKE ACUR MODEL TSX STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34 DAMAGE YES NO YES[:] NO✓ 13❑ REGISTERED OWNER INFO ARNEANDERSON221DUVALLAVESERENTONWA98059 VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE INSURANCE CO USAA 01823 10 89R 4 LI EFFECT I SUR N# TOPVEHICLE CHARGE 36 LEGALLY YES NO CITATION# 3A0387738 INATTENTIVE DRIVING <1�3 orrom 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHON YE 16 E �U—NIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ s NO 1/ D:4254420360 a LAST NAME LARSON FIRST NAME KENDALL MIDDLE I S INITIAL 17❑ STREET ❑', 8215 121 ST AVE SE CITY l NEWCASTLE ST WA ZIP 980564407 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 DRIVER # INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE BZN5457 TAre WA vIN1t 3CZRU6H5XMM735855 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2021 MAKE NOND MODEL yR-V STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO GREGORY LARSON 8215121STAVE SE NEWCASTLE WA 98056 VEHICLE NO.2 SHADEDAMAGEbAREA s Cd LIABILITY INSURANCE INSU PORGY#ECO ALLSTATE817895451IN STOP VE""LE ❑ Nu,J CITATION# CHARGE to BOTTOM LEGALLY YES 25 ' OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 J.M/TCHELL 10377 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED74272 COLLISION REPORT III III III III III 111 1591972 CASE# 23-7092 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) NGUYEN JAYDEN N (LAST FIRST, ADDRESS&PHONE# 1401 EDMONDS AVE NE RENTON WA 980562760 SEX M MMDDyyvv 04 - 12 - 2007 PASSENGER I�I WITNESS� UNIT# 1 pO 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE of INJURIES L�!1 USE .CLASS '1 NAME (LAST,FIRST,MIDDLE INITIAL) - CLEMMONS ELLS S ADDRESS&PHONE# D O B 6222 SE 2ND ST RENTON WA 980598586 SEX' F MMDDyvvv 07 _ 19 _ 2006 SEAT HELMET I INJURY NATURE of INJURIES PASSENGER RV WITNESS UNIT# 1 POS. 6 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1 NAME MIDDLE INITIAL) HOWE SHUHALA (LAST FIRST, AppRESS&PHONE# RENTON _ SEX U. D.O.B. - MMDDYYYY PASSENGER WITNESS UNIT# ! 1 SEAT 4 AIRBAG 2 RESTR. 4 EJECT 1 HELMET NJURY 1 NATURE OF INJURIES ❑ POS. USE CLASS ----� NARRATIVE' On 062223 1 responded to a 3-vehicle non-injury/non-blocking collision that occurred near the 1600 block of Duvall Ave NE. I contacted the driver of unit 2 who told me they were slowing for traffic while traveling in the #2 lane of northbound Duvall Ave NE when she was rear-ended by unit 1. Because of the impact, unit 2 was pushed into the rear bumper of unit 3. The driver did not request medical attention. Rear and front bumper damage to unit 2. 1 contacted the driver of unit 3 who told me they were stopped for traffic while traveling in the #2 lane of northbound Duvall Ave NE when he was rear-ended by unit 2. The driver did not request medical attention. Rear bumper damage to unit 3. 1 contacted the driver of unit 1, identified as Drew A Anderson (dob 09-16-2006) via her WA DL. Anderson was following unit 2 in the #2 lane of Duvall Ave NE. Anderson was unable to stop in time as unit 2 was slowing and ended up rear-ending unit 2. The impact pushed unit 2 into unit 3. Anderson did not request medical attention. Unit 1 sustained heavy front-end damage. But not for the action of UNIT 1 DRIVER the result would not have happened. I cited Anderson via SECTOR under RMC 10.12.25-Inattentive Driving I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. J.MITCHELL 06-22-23 12:09 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 612712023 2:15:21 PM BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED 10:30 AM TIME POLICE ARRIVED 10:40 AM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. ED74272 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-7092 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER 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 YES NO D:2065046048 0 7 29 LAST NAME WU FIRST NAME JIANLONG MIDDLE' N INITIAL STREET 30 NEW AnDRFSP' 4110 SE 1ST PL CITY RENTON ST WA ZIP 980595229 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs No NTERLOCK YES�NO� YEs N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 05 - 27 - 1958 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE ATM5655 [TAT WA VIN# 2T3DFREVOFW257866 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2015 MAKE TOYT I MODELRA W STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1G P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFOXANLONG WU4110 SE 1STPL RENTONWA98059 J 9 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE INSURANCE CO STATE FARM 4886764 C3147 gTOp IN EFFECT &POLICY# EHICLE o BarroM 34 13 LEGALLY YES NO 01 CITATION# CHARGE STANDING �}� 8 7 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 35 15 LAST NAME FIRST NAME INITIALAL MDDLE ❑ ET 16 STRETRE "F ' CITY ST ZIP NEW CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ 39 LICENSE vIN# PLATE# rnr 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ TRLR TRLR 41 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 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LeGALLv 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. J,MITCHELL 06-22-23 12:09 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 25 ORID# 10377 O#I',WA0171300 JACOBS 612712023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. ED74272 CASE# 23-7092 DATE AND TIME 06/22/2310:30 OF COLLISION w z a: Nt Sun��t I:3lvti. PAGE 4 OF 4