HomeMy WebLinkAbout24-2736 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-2736 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 03 - 1-- 2024 1207 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 172ND STREET BLOCK ST e✓
MILEPOST 12700
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 338 00 FEET MILES e S ❑ W e 128THAVESE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4252699870 0 9 30
6� LAST NAME WILLIAMS FIRSTNAME LAUREN MIDDLE T 1 2 31
INITIAL
STREET ❑ 22614 212TH AVE SE CITY MAPLE VALLEY ST WA 7jp, 980380000 z
NEW ADDRESS
❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
7
iNTERLOCKYEs NO 1/ INTERLOCKYEs 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❑ PI ATFBit BUZ0205 sTArI WA urN#' 2FMDK39C28BA32528
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 2 2008 FORD EDGE SV DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO LAUREN WILLIAMS PO BOX 1062 MAPLE VALLEY WA 98038 D:4252699870 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 10BOTTOM 5 36
LEGALLY YES NO CITATION# 4A0071577,4AO071577 INATTENTIVE DRIVING,OP MOT VEH
15❑ STANDING 8 6
MOTOR PEDAL-: 'PEDESTRIAN PROPERTY L DAM THR OD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:8776929729
16 a
LAST NAME us FIRST NAME KEITH MIDDLE IL
INITIAL
17 STREET❑ NEW ADDRESS❑' 19201 EVERGREEN DR CITY BONNEY LAKE ST WA ZIP 983918437 37
18❑ CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NOF,/
19 F] LICENSE# STATE WA SEX M M DDY
D.C.B.
08 _ 10 _ 1968 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 2 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑LICENSE I 21❑ PLA E# C52687G TArE 41
WA VIN# 3BPDX20X7HF173923 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE PTRg MODEL 520 STYLE GG VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO RABANCOLTEI.01076THAVES KENTWA98032 D:8776929729 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#ECO ACE AMERICAN ISA H10735786IN I STOP
VEwCLE CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N�
❑ s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE60152
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2736
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 NJURY 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'
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.
MATTHEW NUGENT 03-13-24 04:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 311812024 11:57:41 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED; 12:10 PM TIME POLICE ARRIVED',12:13 PM
PART I PAGE IT]OF 4�
REPORT NO. EE60152 CASE# 24-2736 OF COLLISION
03/13/24 12:07
OF CbLLI510N
NARRATIVE
24-2736
On 03/13/2024 at approximately 1210 hours, I was dispatched to a blocking vehicle collision in the
12700 block of SE 172nd Street, within the City Limits of Renton, County of King, State of
Washington.
Upon arrival, I confirmed there were no complaints of injury from either of the involved parties
requiring immediate medical response at the time of report. There, I collected the each of the involved
driver's information and their independent recollection of the events leading up to the collision.
The driver of Unit#1 said she was the sole occupant of her vehicle and was traveling eastbound in
about the 12700 block of SE 172nd Street and approaching the intersection of 128th Ave SE. The
driver of Unit#1 stated she was traveling directly behind Unit#2 but did not notice as Unit#2 had
stopped in the roadway. The driver of Unit#1 stated that she attempted to stop her vehicle but
subsequently collided with the rear of Unit#2 causing moderate damage to the front of Unit#1.
The driver of Unit#2 said he was the sole occupant of his company vehicle (Republic Services
Garbage Truck) and was also traveling eastbound in the 12700 block of SE 172nd Street. The driver
of Unit#2 stated he had come to a stop for trash pick up. While Unit#2 was stopped, Unit#1 collided
with the rear of Unit#2 causing minor damage to the rear bumper/bracket of Unit#2.
Based on the above statements, I determined that the Driver of Unit#1 (Williams) was the
predominant factor for the cause of collision due to not paying attention to traffic stopped in front of
her causing a collision.
I issued Williams a citation in-person for Inattention causing a collision. Williams also admitted to not
having motor vehicle insurance and was therefore cited in-person for Operating a Motor Vehicle
without insurance.
Both involved vehicles were able to be driven away without further incident. An exchange of
information was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 3/13/2024 4:25 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EE60152 CASE# ' 24-2736 DATE AND TIME 03/13/24 12:07
OF COLLISION
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