HomeMy WebLinkAbout24-7346 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
CASE 24-7346 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 07 - 14 - 2024 0930 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 3RD ST BLOCK NO. e✓ 1800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2548138815 0 11
30
6� LAST NAME HICKLEN FIRSTNAME HATTIE MIDDLE R 1 2 31
INITIAL
STREET ❑✓ 4167 FLORENCE DR CITY IRVING ST TX 2jp', 75038 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
� ON DUTY❑ STATUS' AIRBAG' 2 RESTR 4 EJECT 1 HU EELMET 2 CLASS 7 LEFTHAND[NATURE OF JURIEs z❑
3
LICENSE CMZ8085 STATE WA VIN# 3GKALTEGORL337386
10 9❑ Pr ATE�
- TRAILER STATE PLAT Eft STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 2 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2024 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 GMC TERRAI UT DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO SIXT TITLING TRUST3150 S 160TH ST#502 SEATAC WA 98188 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO EMPIRE FIRE AND MARINE RSF5185385.04 4
LI EFFECT I SUR N# TOPVENICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4256383284
16 a
LAST NAME 0RELLANA MEJIA FIRST NAME JENIFER MIDDLE
INITIAL
17❑ STREET NEW ADDRE— 13404 NEWCASTLE COMMONS DR CITY NEWCASTLE ST Wq ZIP 98059 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDIIVEW # STATE WA SEX F M .O.B. 12 _ 23 _ 1995 39
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HE 2 INJURY 5 NATURE of INJURIES 40
USE CLASS NECK PAIN
LICENSE I ❑21❑ PLA E# CDL7206 TATE WA VIN# 41
SXXGN4A74FG511222 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
TOWED BV Gov HI 44
VEH YEAR 2015 MAKE /(//� MODEL QP'I'/M/� STYLE $D —FEHICLE
TOWED✓ NOO BLIN GENE MEYERS YES NO�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE❑ INSU PORGY#E CO GIECO4368007433IN 9TOP
'E""LE ❑ Nu
J
,J� CITATION# CHARGE
25 to BOTTOM
L LLY YESEGA '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
OF CUM ING 11488 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE95944
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7346
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HICKLEN JAMES L
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
4167 FLORENCE DR IRVING TX 75038 2548139156 SEX M MMDOYyry 12 - 31 - 1955
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 POS. : 3 2 4 1 USE 2 CLASS I1
NAME
(LAST,FIRST,MIDDLE INITIAL) DAVIS BLAIRE
ADDRESS&PHONE# D O B
10404 168TH AVE NE REDMOND WA 98052 SEX F MMDDYYvv 03 _ 22 _ 2018
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 1 POS. 9 AIRBAG 2 RESTR. 12 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) DAVIS JR BRIAN
AooREss&PHONE# 10404 168TH AVE NE REDMOND WA 98052 M I. 09 05 _ 2011
SEX. D.O.B. _
MDDYYYY
PASSENGER WITNESS UNIT# ! 1 SEAT 7 AIRBAG 2 RESTR. 12 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
❑ POS. USE CLASS 7�----�
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.
TIM CUMMING 07-14-24 03:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 711512024 2:47:15 PM
BADGE OR ID# 11488 OR]# WA0171300 TIME POLICE DISPATCHED 9:35 AM TIME POLICE ARRIVED]9:41 AM
PART I PAGE IT]OF 6�
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE95944
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7346
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HODGES KELEEA
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
205 W 5TH AVE#105 ELLENSBURG WA 98926 5096070271 SEXi F MMDOYyry 11 - 13 - 1980
PASSENGER I�I WITNESS� UNIT# 3 SEAT POS. 3 AIRBAG 2 RESTR. 4 EJECT ? 1 USE HELMET 2 CLASS
L NATURE of INJURIES
L�!1 I1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDVYYV
PASSENGER [:]WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
TIM CUMMING 07-14-24 03:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 711512024 2:47:15 PM
BADGE OR ID# 11488 OR]# WA0171300 TIME POLICE DISPATCHED 9:35 AM TIME POLICE ARRIVED]9:41 AM
PART I PAGE 3�OF 6�
REPORT NO. EE95944 CASE# 24-7346 OF COLLISION
07/14/24 09:30
OF CbLLI510N
NARRATIVE
24-7346
On 07/14/2024 at approximately 0937 hours, I was working as a Police Officer for the city of Renton.
While I was working, I was dispatched to a blocking collision near the intersection of Ne 3rd St and
Monterey Dr NE, in the City of Renton, the County of King, State of Washington. When I arrived on
scene, I found the collision had taken place in the 1800 block of NE 3rd St, in the westbound lanes,
and in lane 2.
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized. My involvement in this incident was captured
on my department issued Axon body camera. For exact statements made during my investigation
please see my Axon camera footage.
According to the notes in the call, just to the east of the Ne 3rd St and Monterey Dr NE intersection,
there was a 3-vehicle collision that was partially blocking westbound 3rd St. It was unknown if there
were injuries. One of the vehicles was smoking and had the hazard lights on. The first vehicle was
described as a black Kia Optima with smoke coming from the hood. The second vehicle was
described as a white Nissan Frontier. The third vehicle was described as a silver crossover.
I arrived on scene around 0941 hours. When I arrived on scene, I saw 3 damaged cars matching the
description that dispatch provided. The first vehicle was a black 2015 Kia Optima sedan (WA LIC#
CDL7206). Jenifer Orellana Mejia (DOB 12/23/1995) was identified as the registered owner and
driver. (This vehicle will be identified as Unit 2 for the duration of this case.)
The second vehicle was a white 2017 Nissan Frontier pickup truck (WA LIC#XMT B9291 C).
Samantha P Cox (DOB 11/11/1995) was identified as the driver and Kelee A Hodges (DOB
11/13/1980) was identified as the passenger. (This vehicle will be identified as Unit 3 for the duration
of this case.)
The third vehicle was a silver 2024 GMC Terrain SUV (WA LIC# CMZ8085). Hattie R Hicklen (DOB
12/27/1955) was identified as the driver. James L Hicklen (DOB 12/31/1955), Blaire Davis (DOB
03/22/2018), and Brian Davis Jr (DOB 09/05/2011) were identified as passengers in the vehicle. (This
vehicle will be identified as Unit 1 for the duration of this case.)
I spoke to each other the parties and learned Unit 3 stopped while traveling west on NE 3rd St when
an unidentified black jeep suddenly stopped in front of it. Unit 3 did not collide with the unidentified
black Jeep but was forced to quickly engage the breaks. The Jeep left the area. When Unit 3
stopped suddenly, Unit 2 stopped as well. Unit 1 attempted to stop due to the other vehicles coming
to a sudden stop but collided with unit 2 and pushed unit 2 into unit 3. The damage for each vehicle
was consistent with the statements made by the involved parties.
The driver of unit 2 stated that her neck was hurting. I later learned that she had previously had a
neck injury and now she was feeling pain in her neck due to the collision. The driver of unit 1 stated
that she had hurt her left hand. Renton Fire was called to the scene and provided each person with
medical attention. The driver of unit 2 was placed onto a backboard and driven to Valley Medical
Center for further medical attention.
All parties provided me with their required information. They were all given my business card and the
case number and encouraged to call their insurance company. It should be noted that unit 3 is
registered to the Kittitas County and they are self-insured. Photos were taken of the scene and
uploaded to evidence.com.
Gene Meyers was called to the scene and towed unit 2 to their lot.
Based on all the information gathered, I am not able to determine the at fault driver. This case is for
documentation purposes only.
There is no further information available at this time.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by T. Cumming #11488 on 07/14/2024 @ 1445 hours in Renton WA.
PAGE 4 OF 6
SUPPLEMENTAL REPORT No. EE95944
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-7346
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 DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO
D:5098909732
rF0 1 29
LAST NAME : COX FIRST NAME : SAMANTHA MIDDLE'.. P
INITIAL
STREET 30
NFW Anr)Rr.� 205 W 5TH AVE#105 CITY ELLENSBURG ST WA ZIP 98926
6 [6 1 1 2 31
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED
INTERLOCK YEs NO zERLOCK YES❑N0� YES N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv 11 - 11 - 1995
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE B9291C TAT GOV VIN# 1N6ADOEV2HN742621
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 2 5 VEH.YEAR2017 MAKE NISS MODELFRONTIE STYLE TR VEHICLE TOME E T SABLIN TOWED BY anvi vFH1C F FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO.KITTITAS COUNTY205 W 5TH AVE#105 ELLENSBURG WA 98926 SHADE IN DAMAGED AREA 3 7 33
12 a
FROM TO
LIABILITY INSURANCE INSURANCE CO SELF INSURED KITTITAS COUNTY q"i"Olx
IN EFFECT &POLICY# 1
EwcLE 34
13 4 LEGALLY YES[:] NO❑ CITATION# CHARGE 0 BOTTUM
STANDING } 7
14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE
❑ 36
STREET
16F] NEW STREET
CITY ST ZIP
CDL IGNITION REdUiREE7 IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK 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 TAT VIN# 39
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
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.
TIM CUMMING 07-14-24 03:09 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORRID# 11488 O#II,WA0171300 APPROVED BY
7/115/2024 PAGE OF 6
3000-345-013(R 11118)
REPORT NO. EE95944 CASE# 24-7346 DATE AND TIME 07/14/24 09:30
OF COLLISION
Not drawn to scale
PAGE 6 OF 6