HomeMy WebLinkAbout23-14202 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE$# 23-14202 2 0 5
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 12 - 11 - 2023 1109 17 ❑.❑ S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD N BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 850 1. 00 FEET ❑ S ❑ W❑ N 3RD ST
❑ MILES N
0 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067792923 0 11
30
6� LAST NAME GRACE FIRSTNAME DARRELL MIDDLE D 1 2 31
INITIAL
STREET 01 17740 151 ST AVE SE APT 4M CITY RENTON ST WA Zjp, 980589080 2
'
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES 2❑
❑
10 9❑ PI ATFBit CJD5871 sTArr~ WA urN#' 1G1ZE5ST8HF109238 3
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
rRLR A RLR 1 1 33
12 3 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 8 2017 CHEV MAL/BU DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO DARRELL GRACE 821 SUNSETBLVD NEAPTE4 RENTON WA 98056 D:2067792923 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
8 INSURANCE CO 2
14 LIABILITY INSURANCE� DAIRYLAND 11408638810
IN EFFECT &POLICY# 9TOP
CHARGE � 10BOTTOM 5 36
15❑ vewcLE
EGHALLY YES❑NO❑ CITATION# 3AO827237,3A0827237 NO VALID OPER LICENSE WITH
STANDING 8 7 6
MOTOR PEDAL-:. 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ No D:3239729611
16 a
LAST NAME ZIMMERLE FIRST NAME TEMPLEALICIA MIDDLE I M
INITIAL
17 STREET I71ST PL SE APT C304 CITY COVINGTON ST WA ZIP 980424997 37
NEW ADOREs�' 26808 1
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INERLOCKYEs❑ND� INTERLOCK ves No� YEs NDF
19 DRIVER'S STATE WA SEX F D.C.B. O6 _ 23 _ 1981 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# BYS4307 TArE WA VIN 1t 2HKRW2H8XMH642178 41
1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2029 MAKE HOND MODEL CR-V STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO TEMPLEALICIAZIMMERLE803NELMAVE PASCOWA99301 D:3239729611 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 6117749045IN 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 s � e
7PLANTAGNE
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
12575 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE30938
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14202
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STONE SUMMER K
(LAST FIRST,
ADDRESS&PHONE# D O.B.
24636 SE 192ND ST MAPLE VALLEY WA 980387306 3239729611 SEX F MMDDYyry 04 - 26 - 1989
PASSENGER Z WITNESS UNIT# 2 PSEAT OS 3 AIRBAG 3 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES
USE CLASS
1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX: MMDDYYYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
P.LANTAGNE 12-12-23 06:54 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 12/15/2023 5:46:17 PM
BADGE OR ID# 12575 OR]4f WA0171300 TIME POLICE DISPATCHED', 11:16 AM TIME POLICE ARRIVED',11:22 AM
PART I PAGE IT]OF 4�
TIME
REPORT NO. EE30938 CASE# 23-14202 OF COLLISION12/11/23 11:09
NARRATIVE
23-14202
On 12/11/2023 at approximately 1109 hours, I, Officer Lantagne, responded to a blocking, non-injury
collision which occurred in the 400 block of Sunset BLVD N, which is located in the City of Renton,
County of King, and the State of Washington. I responded in my fully marked police vehicle, wearing
my patrol uniform.
I arrived on scene and observed Unit#1, a 2017 Chevrolet Malibu with license plates CJD5871
issued out of Washington State, and Unit#2, a 2021 Honda CR-V with license plates BYS4307,
parked in the lot of the Safeway. I was advised there were no injuries.
I contacted the driver of Unit#1, Darrell D. Grace (DOB 05/06/2003), who told me the following:
Grace was driving southbound in the inside lane of Sunset BLVD N in the 400 block. Grace attempted
to make a U-Turn to drive northbound up to his residence and did not see Unit#2. The right rear of
Grace's vehicle was struck by Unit#2.
1 contacted the driver of Unit#2, Templealicia M. Zimmerle (DOB 06/23/1981), who told me the
following: Zimmerle was driving northbound on Sunset BLVD N in the 400 block in the inside lane.
Unit#1 made a left turn in front of Zimmerle and she could not stop her vehicle in time. The front of
Zimmerle's vehicle struck the rear passenger side of Unit#1.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had significant crumple damage to the rear passenger side
of the vehicle. The rear passenger wheel was broken off from the hub. Unit#2 had significant
damage to the right front bumper and hood which was crumpled in to the engine.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Grace and Zimmerle. I observed Grace's driver's license
was suspended in the third degree. I issued Grace an infraction for failing to yield the right of way
while making a left turn against traffic, and for operating a motor vehicle without a valid driver's
license with a valid ID.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 0728 hours on 12/12/2023 at Renton, WA.
PAGE 3 OF 4
REPORT NO. EE30938 CASE# ' 23-14202 DATE AND TIME 12/11/23 11:09
OF COLLISION
Not Case #23-14202
i Scale
Unit #1
PAGE 4 OF 4