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HomeMy WebLinkAbout24-2678 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 INTERSTATE ❑ CITY STREET FIRE ❑ CASE 24-2678 2 RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 RESERVATION STRUCK z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION.. 03 - 11 - 2024 1557 17 �. S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ OAKSDALE AVE SW BLOCK NO. e ❑ MILEPOST 4a❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e S 180TH ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:5097698490 0 81 30 6❑ LAST NAME FRENCH FIRSTNAME JEFFEREY MIDDLE G 1 1 2 31 INITIAL STREET ❑ 12708 142ND AVE CT E CITY PUYALLUP ST WA ZIP 98374 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID LOB 05 1— 25 — 1972 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 2 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑ 3 10❑ P1 ATE 14 DP55323 STATE WA v N# 3C4PDCBG7DT677277 C....� TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 0 0 VIN#' VIN# >; FROM TO ❑ VEH.YEAR 2013 DODG JOURNE VN MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE g 9 13 34 4 DAMAGE YES NO YES[:] No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE INSURANCE CO STATE FARM 3395217FO8470 4 LI EFFECT I SUR N# TOPVEHICLE CHARGE 36 LEGALLY Yes❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2064669590 16 a LAST NAME GONZALEZ FIRST NAME ALEJANDRO MIDDLE JE INITIAL 17❑ STREET NEW ADOREss❑' 22921 3OTH AVE S APT 106 CITY DES MOINES ST WA ZIP 98198 4❑ 37 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 LICENSE# STATE WA SEX M M D.C.B. 08 _ 29 _ 1979 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑ 41 CLS 21❑ ILICENSE PLA E# BNE5100 TATE WA VIN# JM1BJ2223X0191861 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. TOWED BV Gov HI 44 VEH YEAR 1999 MAKE IlggZp MODEL pROTEG STYLE $D —FEHICLE TOWED✓ No0 BLIN GENE MEYERS YES Noy/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEbAREA s Cd LIABILITY INSURANCE &POINSURGY#E CO WA AUTO INSURANCE 5547312IN STOP VEHICLE CITATION# CHARGE 25❑ to BOTTOM LEGALLY YES N� OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 MICAH BATTLE 12049 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE61837 COLLISION REPORT III III III III III 111 1591972 CASE# 24-2678 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME (LAST FIRST,MIDDLE INITIAL)_ ADDRESS&PHONE# SEX D.O.B. - - MMDDYYYY. PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D D B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' 24-2678 On 3/11/24 at 1556 hours, I was dispatched to an injury collision at S 180th St & Oaksdale Ave SW within the City of Renton, County of King, Washington. Unit 1 was identified as Jefferey G. French (5/25/72) who was driving WA-DP55323. Unit 2 was identified as Alejandro E. Gonzalez (8/29/79) who was driving WA-BNE5100. Unit 3 was identified as David B. Bunkelman (11/15/60) who was driving WA-C31477P. Unit 1 stated he remembered just slamming on the break really hard before colliding with the rear end of Unit 2. He also claimed he was not distracted. Unit 2 stated he was just waiting at the red light when Unit 1 hit him in the rear causing him to struck Unit 3 in the rear. Unit 3 stated he was just waiting at the red light when Unit 2 struck his rear end. Unit 3 complained of serious neck pain and was transported to Valley Medical Hospital. I observed moderate damage to the front end of Unit 1. Extensive damage to the front and rear end of Unit 2, which was towed at the scene. I also observed moderate damage to the rear end of Unit 3. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAH BATTLE 03-11-24 04:45 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 3/23/2024 4:11:50 PM BADGE OR ID# 12049 ORI# WA0171300 TIME POLICE DISPATCHED; 3:57 PM TIME POLICE ARRIVED';4:00 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. EE61837 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-2678 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 DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER � YES NO D:2537364615 OF 8 29 LAST NAME BUNKELMAN FIRST NAME DAVID MIDDLE B INITIAL STREET 30 ❑ NEW AnDRFSP' 12211 SE 206TH ST CITY KENT ST WA ZIP 98031 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs NO NTERLOCK YES�NO� vES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 11 - 15 - 1960 7 HELMET I INJURY' NATURE OF INJURIES ON DUTY❑ STATUS AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 5 EXTREME NECK PAIN/PREVIOUS INJURY 8 ❑ 1 32 LICENSE C31477P TAr WA VIN# 3GCUKREC4JG167395 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.It VIN.#. 11 0 0 VEH.YEAR2018 MAKE CHEV I MODELSIL VERA STYLE PK I VEHICLE TOWS E T SABLIN TOWED BY anvi vEH11' 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 LIABILITY INSURANCE INSURANCE CO SAFECO UNKNOWN q"i"Olx IN EFFECT &POLICY# 1 EwcLE 34 13 4 LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTUM STANDING } 7 14 ❑ UNIT Tr Vd IRE 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 REQUIRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE rnr 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. MICAH BATTLE 03-11-24 04:45 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12049 O#IL WA0171300 SCOTT 3/23/2024 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EE61837 CASE# ' 24-2678 DATE AND TIME 03/11/24 15:57 OF COLLISION *Not to Scale PAGE 4 OF 4