HomeMy WebLinkAbout24-6654 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
CASE#r` 24-6654 2
RESULTED
1 STOLEN
STATE ROUTE � OTHER ❑ VFHIC;I F ❑ LOCAL AGENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 06 - 1-- 2024 2048 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 1820
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 80 00 FMILES N EET e S ❑ E e CEDAR RIVER PARK DR
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:9999999999 0 81
30
6� LAST NAME JOHNSON FIRSTNAME JOHN MIDDLE T 1 2 31
INITIAL
STREET ❑, 1170 S ELM ST,APT 7 CITY COLVILLE ST WA ZIP 99114 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYES NO 1/ I INTERLOCK YES NO�/ YES 1/ NO
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMET 2 INJURY 5 NATURE OF INJURIES 2❑
USE CLASS HEAD TRAUMA AND COMPLAINT OF CHEST PAW
3
10[1Pl QEES# DP77207 STATE WA VIN If 1 G3CX54C3L4312417
TRAILER STATE TRAILER STATE
11 4 ] PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 4 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE R T 34
13 3 1990 OLDS 98 P4 YES NO � g MEYERS TOWING YES[:] No
DAMAGE
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv YFS❑NO❑ CITATION# 4AO047930 FAIL STOP AT STOP I o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- pEDES7RIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068061278
16 a
LAST NAME ZOU 77771 FIRST NAME WENNI MIDDLE
INITIAL
17 STREET IS❑' 16704 126TH AVE SE CITY RENTON ST WA ZIP 98058 37
NEW ADOREs
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/
19 LDI IVER # STATE WA ]SEX IF M .C... 08 _ 30 _ 1975 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CLE0517 TATE 41
WA VIN# 1FMSK8DH6MGA63467 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2021 MAKE FORD MODEL EXPLORE STYLE P4 DAMAGE TOWED✓ NOO BLIN GENE MEYER TOWING YES No
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO COUNTRY FINANCIAL PA4197752IN I STOP
VE""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES N�
❑ s
7NELSON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12421 WA0171300
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE92199
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6654
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DOLSON DELANN M
(LAST FIRST,
ADDRESS&PHONE#
2311 BLUE CREEK LOCKS RD ADDY WA 99101 9999999999 SEXi F MMDOYyvv 10 - 26 - 1965
SEAT HELMET INJURY NATURE of INJURIES
PASSENGER ZWITNESS� UNIT# 1 POS. 5 AIRBAG',1 RESTR. q EJECT 1 USE 2 CLASS 5 HEAD TRAUMA,PAIN TO RIGHT
LEG
NAME
(LAST,FIRST,MIDDLE INITIAL) READ EDWIN R
ADDRESS&PHONE# D O B
1562 HIGHWAY 20 E COLVILLE WA 99114 5099354605 SEX' M MMDovvvv 04 _ 20 _ 1962
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER �WITNESS� UNIT# 1 POS 3 AIRBAG'1 RESTR. 4 EJECT 1 USE 2 CLASS 5 HEAD TRAUMA
NAME
(LAST FIRST,MIDDLE INITIAL) WEBSTER KEETO D
AooREss&PHONE# 12601 68TH AVE S UNIT 18B SEA TTLE WA 98178 2065197661 SEX M D.O•B. O6 I. _ 15 _ 2002
MDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT 9 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 NJURY 6 NATURE OF INJURIES
�. POS. USE :CLASS COMPLAINT OF PAIN TO MOUTH
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.
D.NELSON 06-23-24 10:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 71212024 4:46:38 PM
BADGE OR ID# ! 12421 OR#' WA0171300 TIME POLICE DISPATCHED! 8:49 PM TIME POLICE ARRIVED',8:52 PM
PART I PAGE IT]OF 4]
REPORT NO. EE92199 CASE# 24-6654 OF COLLISION
06/23/24 20:48
OF CbLLI510N
NARRATIVE
24-6654 COLL
On 6/23/2024 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of blocking collision with injuries in front of 1820 Maple
Valley Highway Renton/King/WA. An involved party and a passerby were calling to report a two-
vehicle collision in the center lane.
I arrived on scene and located a gold 1990 Oldsmobile 98 WA/DP77207 had rear-ended a blue 2021
Ford Explorer WA/CLE0517. The vehicles were blocking the number two lane in the 1800 block of
Maple Valley Highway. The Oldsmobile had extensive damage to the front bumper/hood and the Ford
had damage to the rear bumper.
RRFA was on scene and treating the occupants of the Oldsmobile, they were later identified as:
Driver: John T Johnson DOB: 4/11/1941
Front middle passenger: Delann M Dolson DOB: 10/26/1965
Right front passenger: Edwin R Read DOB: 4/20/1962.
John had a bloody nose, complaint of head pain, and complaint of chest pain. Delann had a
laceration on her head, complaint of head pain, and complaint of pain to her right leg. Edwin had a
complaint of head pain and a laceration to his head. John, Delann, and Edwin were all transported to
Valley Medical Center by Tri-Med for further evaluation.
I was not able to speak with John or Delann due to the medical treatment they were receiving, Edwin
told Officer Bowie that he was sleeping and had no idea what happened.
I then spoke with the driver of the Ford who was identified as Wenni Zou DOB: 8/30/1975. Wenni said
she was not injured and said that she was stopped for traffic at the light when she was struck by the
Oldsmobile. The damage to both vehicles was consistent with this account of events.
Wenni was driving for a ride-share service and had a passenger on-board who was identified as
Keeto D Webster DOB: 6/15/7661. Keeto also said that they were stopped for traffic at the stop light
when they were struck by the Oldsmobile.
Both vehicles were removed from the scene by Gene Meyer Towing.
I completed a Sector citation #4A0047930 for RCW 46.61.190 Failure to Stop/Yield at Intersection.
This citation should be mailed to John at his DOL address.
Nothing further.
PAGE 3 OF 4
REPORT NO. EE92199 CASE# 24-6654 DATE AND TIME 06/23/24 20:48
OF COLLISION
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PAGE 4 OF 4