HomeMy WebLinkAbout23-14240 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-14240 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC WA0171.300 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 5 TRIBAL 02
TOTAL#OF OBJECT 1 1 8 28
UNITS ❑
RESERVATION I I
STRUCK z
3 M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
c us oN 12 - 12 - 2023 0740 17 ❑.= E IN e 1070 3
S 8
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 164TH ST BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 20 00 FEET e MILES S ❑ W e 108THAVESE
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067908345 0 7 30
6� LAST NAME MERCADO FIRSTNAME ELIDA MIDDLE T 1 2 31
INITIAL
STREET ❑ 1646 INDEX AVE SE CITY RENTON ST WA 2jp, 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ p)a'r�S�t BRJ2916 sTAr� WA VIN# 2HKRM4H30EH715338
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2014 HOND CR-V UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14� LIABILITY INSURANCE INSURANCE CO ALLSTATE 964 588 500 3
IN EFFECT &POLICY# 9TOP
VEIF" CHARGE 36
LEGALLY YEs❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2539937861
16 a
LAST NAME PETERSON FIRST NAME KRISTINA MIDDLE IM
INITIAL
17 NEW STREETREs7' 14921 SE 177TH PL APT 23-H CITY' RENTON ST WA ZIP 98058 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK yEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.C.B. 07 27 1982 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 6 PAIN TO BACK,F—NATURE OF i NECK,LEG ❑ES 40
❑ 41
21❑ ILICENSE PLA E# AEY8394 TArE WA VIN# 4S3BMBC6163255220 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GI
VEH YEAR 2011 MAKE S(JB�4 MODEL LEGACY STYLE 4D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSURANCE
#E CO NATIONWIDE 7246JO55753IN STOP 5
VEHICLE YES[:] N,.I it I CITATION# CHARGE to BOTTOM
LEGALLY
25 N.HVCa
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ROSEANNE HYNES 12612 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE31080
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14240
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STRANGE LILLY
(LAST FIRST,
ADDRESS&PHONE#
14921 SE 177TH PL APT 23-H RENTON WA 98058 SEXi F MMDOYyvv 09 - 28 - 2010
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET NJURY NATURE OF INJURIES
❑✓ 2 POS. 3 2 4 1 USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) EALY TAYLOR
ADDRESS&PHONE# DOB
14921 SE 177TH ST 23-H RENTON WA 98058 SEX F .M.D vv 04 _ 27 _ 2014
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) ROBINSON ISABELLA
AooREss PHONE# 14921 SE 177TH PL 23-H RENTON WA 98058 SEXF 02 22 _ 2018
. D.O.B. _
MMDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT g AIRBAG 2 RESTR. 10 EJECT 1 HELMET 2 NJURY 1 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.
ROSEANNE HYNES 12-15-23 10:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 12/16/2023 5:06:55 AM
BADGE OR ID# 12612 ORI# WA0171300 TIME POLICE DISPATCHED 7:42 AM TIME POLICE ARRIVED',7:51 AM
PART I PAGE IT]OF 5�
REPORT NO. EE31080 CASE# 23-14240 OF COLLISION
12/12/23 07:40
OF CbLLI510N
NARRATIVE
On 12/12/2023 at 0745 hours I was in full patrol uniform and driving a marked Renton Police patrol
vehicle when I was dispatched to S 27th St and 108th Ave SE in the city of Renton, County of King,
State of Washington regarding a traffic collision.
Upon arrival, I saw V1 (WA LIC# BRJ2916) and V2 (WA LIC#AEY 8394) in the roadway on SE 164th
St facing west and just east of 108th Ave SE. Both V1 and V2 were resting on all four wheels. The
back of V1 was touching the front of V2. It appeared they had collided and were stuck together. The
front of V2 was touching the back of V1. I did not see airbags deployed in either vehicle. V1 sustained
major damage to the rear and V2 sustained major damage to the front. It should be noted that when
V1 and V2 separated, the shape of V1's rear appeared mostly normal but I suspected severe damage
to the bumper because it had been indented when I arrived on scene. Renton Fire was on scene
when I arrived. Both D1 and D2 declined medical assistance.
I spoke with D1-Elida T. Mercado and she told me in summary: She was driving her vehicle and
attempted to make a right turn (northbound) onto 108th Ave SE from SE 164th St. As she made the
right turn, a yellow school bus was making a left turn from 108th Ave SE to eastbound SE 164th St.
As the school bus turned, it almost struck her vehicle. D1 said her vehicle then began to slide
backward on SE 164th St where it collided into V2. D1 said she did not reverse her vehicle. She said
her vehicle began sliding and she had no control of the vehicle. I asked D1 if she was injured and she
said no. She expressed that she has a feeling of nervousness in her abdomen. I asked her to clarify if
it was a physical injury or emotional and she confirmed it was emotional. She was shaken up from the
accident. I did not observe visible injury upon her.
I spoke with D2-Kristina M. Peterson and she told me in summary: She was in her vehicle on SE
164th St facing west toward the intersection at 108th Ave SE. She was stopped behind V1. She was
awaiting her turn to approach the stop sign when she saw V1 attempt to make a right turn onto 108th
Ave SE. D2 said she then saw V1 go into reverse and drive backwards until it collided into the front of
her vehicle. D2 said she believed D1 may have freaked out because there was a school bus driving
south on 108th Ave SE. D2 emphasized that based on the damage to the vehicles it appeared that
she rearended V1, she did not. She said she saw V1's reverse lights on as V1 drove backwards and
collided into her vehicle. D2 complained of pain to her back, pain and stiffness in her neck and pain to
her right leg. D2 declined medical assistance. I did not see visible injury upon her.
D2 also stated that her three children were in the vehicle with her. Her 13-year-old daughter, Lilliam
Stranger, was sitting in the front passenger seat. Her 9-year-old daughter, Taylor Ealy, was sitting in
the rear left seat. Her 5-year-old daughter, Isabella Robinson, was sitting in the rear right seat in a
booster seat. D2 said her children did not have injuries or complain of injuries. Her children were not
on scene because they went to school prior to officers' arrival.
V2 was privately towed from the scene. V1 was driven from the scene. Both drivers exchanged
information on scene. I have nothing further.
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.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: R. Hynes #12612 Date & Place: 12/12/2023 @ 1540 hrs Renton, WA
PAGE 3 OF 5
REPORT NO. EE31080 CASE# 23-14240 OF COLLISION
12/12/23 07:40
OF CbLLI510N
NARRATIVE
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Surface Condition: FOGGY, SLIGHTLY MOIST
**** END OF AUTO-POPULATED SECTION ****
PAGE 4 OF 5
REPORT NO. EE31080 CASE# 23-14240 DATE AND TIME 12/12/23 07:40
OF COLLISION
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