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Home My WebLink About24-482 ITFF' "POLCERA II I !�� I III I III I IIII III II I . B 27c COLLISION REP FIT 1591971 ❑ ❑ 24-482 z FIRE ❑ CASE# INTERSTATE CITY STREET RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT i TRIBAL UNITS 03 STRUCK' BUILDING RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CowsloN 01 - 1-- 2024 1341 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BREMERTON PL NE BLOCK NO. e✓ 100 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5 A❑ 400 00 FMILES EET e S ❑ E e BREMERTON AVE NE 0 1 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:4254948011 1 4 30 6� LAST NAME BROCK FIRSTNAME CLIFFORD MIDDLE A 1 2 31 INITIAL STREET ❑ 201 UNION AVE SE UNIT 59 CITY RENTON ST WA Zjp 98059 2= NEW ADDRESS ]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ P1 QTNFS# AFN5314 sTAr W/a u N# 1 D4PU4GX86W505946 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 0 0 VIN#' VIN# 2011 DODG NITRO UT plsA FROM 34 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE 13- DAMAGE YES NO 1/ YES[:] NO✓ REGISTEREDOWNERINFO CLIFFORDBROCK201UNIONAVESEUNIT59 RENTON WA 98059 D:4254948011 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE NPOLICY E CO FARMERS 195462186 4 IN EFFECT &POLICY# TOPVEHICLE CHARGE 36 LEGALLvYFS❑NO CITATION# <1�3 OTTOM 15❑ STAIN,"' 6 UNIT 02 VEHICLE Z CYCLE ❑ PEDESTRIAN ❑ OWNER YES ❑ DYES NO OLD MET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET CITY RENTON ST ZIP 4 17❑ NEW ADDRESS❑ ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑ 19 LLIICENS # STATE SEX U MMDDYY 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG g RESTR 9 EJECT '1 USE 9 CLASS 0 ❑ ❑ILICENSE 21❑ PLATE# 725VOV TAre 41 WA VIN1 1NXBR30E57Z785268 1 42 22❑ PLATE# STATE pLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. YEAR 2007 MAKE TOYT MODEL COROLL STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 VEH L4❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO REBECCA COIL 169 BREMERTON PL NE RENTON WA 98059 D:5094321966 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO I 9TOP VE""LE ❑ N`L J ,J� CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES $ ' 7NE NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 ON 12327 WA0171300 PART A PAGE 01 OF 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE61714 COLLISION REPORT III III III III III 111 1591972 CASE# 24-482 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 PM 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' 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. T.NELSON 01-14-24 04:03 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 3/23/2024 4:00:59 AM BADGE OR ID# 12327 ORI# WA0171300 TIME POLICE DISPATCHED 1:54 PM TIME POLICE ARRIVED:2:03 PM PART I PAGE IT]OF 5� REPORT NO. EE61714 CASE# 24-482 OF COLLISION 01/14/24 13:41 OF CbLLI510N NARRATIVE Unless otherwise noted, the following occurred in the City of Renton, County of King, WA. On 01-14-2024 at approximately 1354 hours I was dispatched to 169 Bremerton PL NE for a collision. Dispatch advised: 1 MVA INTO RPS GARAGE, NI, ELDERLY MALE DRIVER SEEMS CONFUSED." I arrived at 169 Bremerton PL NE and observed unit 1 which was stationary in the driveway, approximately 30 feet in front of the garage door. The garage door appeared to have been struck by a vehicle as the door was caved inward toward the house. I was led to believe unit 1 struck the garage door. Unit 1 had minor front end damage which appeared consistent with striking the garage door. I contacted the driver of unit 1, identified via WA DOL photo as Clifford A. Brock (02-06-1947). Clifford advised he recently left the hospital for treatment for his heart. He was trying to get home when he took a wrong turn and became lost. Clifford saw the driveway to the aforementioned residence, and believed it was the road. Clifford drove down the driveway and struck the garage door before realizing he was not on a road. It did not appear reasonable that Clifford could mistake the driveway for a road, and certainly did not appear reasonable for it to require him to strike the house to realize his mistake, however I did not observe any signs of drug or alcohol impairment in Clifford, and rather suspected he may be having some type of medical episode. I requested the fire department to respond, and they arrived and evaluated Clifford. The fire department advised that Clifford had high blood pressure, and seemed disoriented and advised that he needed to go to the hospital for further evaluation. A Tri-Med responded, and Clifford was medically transported to the Seattle VA hospital. Clifford advised that he does not have any family members in the area, but stated a neighbor would be able to assist with securing his vehicle. Clifford's neighbor responded and drove Clifford's vehicle home for him at his request. I contacted the owner of the residence, identified via WA DOL photo as Rebecca A. Coil (08-31- 1989). Rebecca advised that she was inside her home when the collision occurred and did not witness the incident. Rebecca showed me the inside of her garage where I observed the garage door had struck her vehicle, unit 2, as well as multiple cabinets. Unit 2 sustained minor damage to the rear bumper. The cabinets and the garage door sustained significant damage. There was nothing to indicate their was structural damage to the home. The scene was photographed, and the photos were uploaded to the case file. Based on the circumstances of the collision, and Clifford's condition. I completed a Driver's License Retest request for Clifford and submitted it to WA DOL. **** AUTO-POPULATED SECTION **** THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER": Location Character: PRIVATE DRIVEWAY **** END OF AUTO-POPULATED SECTION **** PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EE61714 r` POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-482 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 A❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:5094321966 MIDDLE.. 29 LAST NAME COIL FIRST NAME REBECCA INITIAL A STREET 30 NEW AnnRFrtP 169 BREMERTON PL NE CITY RENTON ST WA ZIP 98059 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]Na� YEs N L DRIVER'S STATE SEX F M�DDYBYv 08 - 31 - 1989 LICENSE 7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE cLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG E FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NEn+AnnREs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 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 ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv 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. T.NELSON 01-14-24 04:03 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OI BADGE 12327 O#I',WA0171300 APPROVED BY 3%2E3/2024 PAGE�OF F 3000-345-013(R 11118) REPORT NO. EE61714 CASE# ' 24-482 DATE AND TIME 01/14/24 13:41 OF COLLISION x. 1 n, PAGE 5 OF 5