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