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Home My WebLink About23-13324 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 23-13324 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 3 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 CITY# ❑ cowsloN 11 - 18 - 2023 2359 17 ❑.❑ N E IN S 8 W H OF e 1070 3 4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ RAINIER AVE N BLOCK NO. e 4a 1❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 10 00 FEET MILES e S B W e AIRPORT WAY 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4083550368 0 81 30 LAST NAME PERALTA FIRST NAME FIDELORENZ-GONZALES MIDDLE 6 INITIAL 1 2 31 STREET ❑, 558 ROSARIO PL NE CITY RENTON ST WA ZIP 98059 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ PI ATE SH2O552 sTArI WAurN#' WAUFFAFL6EN013908 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO FT -R TPILF1 1 5 33 12 0 0 VIN#' VIN# FROM TO ❑ VEH.YEAR 2014 AUDI A4 SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR YMEYERS GO VT.VEHICLE 9 9 34 13 4 DAMAGE YES NO � YES❑ NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO GEICO 6068630646 4 IN EFFECT &POLICY# TOPVEHCLE CHARGE 36 LEGALLYYES❑NO❑ CITATION# 3AO703674 SPEED TOO FAST FOR CONDITIONS <1�3 orrom 15❑ STANDING 6 MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES 1/ NO D:2069402401 VEHICLE CYCLE OWNER 16 a LAST NAME ANDERSON FIRST NAME WILLIAM MIDDLE C INITIAL 17 STREET NEW ADOREs7 20019 139TH WAY SE CITY KENT ST WA ZIP 98042 37 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑No� INTERLOCK Y�EsI I I NOF YEs t l NO� 19� DRIVERS # STATE WA SEX M Mr D.C.B. 04 03 _ 1983 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 LICENSE I ❑21❑ PLA E# CFH0140 TArE WA VIN 1 41 2FMPK4G99MBA63294 1 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2021 MAKE FORD MODEL EDGE STYLE SO VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO WILLIAM ANDERSON 20019139TH WAY SE KENT WA 98042 D:2069402401 VEHICLE NO.2 SHADEDAMAGEbAREA s Cd LIABILITY INSURANCE &POINSURGY#E CO GENERAL 53-WA 9912269IN STOP VE—Le CITATION# CHARGE 25 to BOTTOM LEGALLY YES Nu ❑ =TURNER NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 12650 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE27730 COLLISION REPORT III III III III III 111 1591972 CASE# 23-13324 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) YOUR SHANNON L (I.P.ST FIRST, ADDRESS&PHONE# D O.B. ' 20019 139TH WAY SE KENT WA 98042 2067473233 SEXi F MMDDYyry 08 - 24 - 1976 PASSENGER WITNESS UNIT# SST AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ ❑ 2 POS. 3 2 4 1 USE 2 CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O E4 SEX MMDDYYYV PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 2 and 3 were stopped at a redlight at the intersection of Rainier Ave N and Airport Way, the vehicle facing soutbound in the right most lane. Unit 1 was traveling south bound on Rainier Ave S, Unit 1 failed to stop in time and collided with Unit 2, this caused Unit 2 to collide with Unit 3. The roads were wet and slick, it appears that Unit 1 was traveling too fast for conditions and failed to stop in time causing the collisions. Unit 1 did not report any injuries, Unit 2 and their front seat passenger did not have any injuries, Unit 3 reported that he had back and neck pain. Unit 3 was transported to the hospital by Trimed. Unit 1's vehicle sustained massive front end damage with front airbag deployment. Unit 1's vehicle was not driveable and towed by Gene Meyers. Unit 2's vehicle sustained minor rear end and front end damage and was still driveable at the time. Unit 3's vehicle had major rear end damage, causing the rear bumper to fall off, the vehicle was still driveable. I have cited the driver of Unit 1 for Driving too Fast for Conditions (RCW 46.61.400). I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. JASON TURNER 11-19-23 08:22 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.TOLLIVER 10540 1 121712023 1:56:21 AM BADGE OR ID# 12650 OR]#' WA0171300 TIME POLICE DISPATCHED 12:11 AM TIME POLICE ARRIVED 12:13 AM PART I PAGE IT]0F 4� SUPPLEMENTAL REPORT NO. EE27730 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-13324 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 i MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:2533498988 0 8 29 LAST NAME KABIRA FIRST NAME ABADURA MIDDLE A INITIAL STREET 30 NEW AnDRFSP' 12233 SE 259TH PL CITY KENT ST WA ZIP 1 98030 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31 INTERLOCK YEs NO NTERLOCK YES�NO� YEs N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 12 - 20 - 1989 7 HELMET INJURY NATURE OF INJURIES ON DUTY STATUS AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 6 BACK PAIN/NECK PAIN 8 ❑ 1 32 LICENSE BUH7451 TAr Wq VIN# JTHBN30F120087327 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN It VIN.#. 11 O O VEH.YEAR2002 MAKE LEXS MODELLS 400 1 STYLE SD I VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1C P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO OWNED BY DRIVER J 9 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO INSURANCE CO R TOIx LIABILITY I EFFECT N/q IN EFFECT &POLICY# 1 EwcLE 34 13 4 LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTUM STANDING } 8 7 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ ET 16 STRETRE "F ' CITY ST ZIP NEW CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YEs NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY -� II 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 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 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. JASON TURNER 11-19-23 08:22 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12650 O#II,WA0171300 APTOLLIVER 12n/2023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EE27730 CASE# ' 23-13324 DATE AND TIME 11/18/23 23:59 OF COLLISION :.''I i .:1 I I <7 j 1 PAGE 4 OF 4