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Home My WebLink About24-498 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 3 27c COLLISION REP FIT 1591971 ❑ ❑ 24-498 z FIRE ❑ CASE# INTERSTATE CITY STREET RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 04 STRUCK' BUILDING RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 01 - 1-- 2024 0828 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ UNION AVE SE BLOCK NO. e✓ 201 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 902 00 FEET MILES e S B W e SE 2ND PL 0 8 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2064914696 1 4 30 6� LAST NAME BROCK FIRSTNAME CLIFFORD MIDDLE 1 2 31 INITIAL STREET ❑ 201 UNION AVE SE UNIT 59 CITY RENTON ST WA Zjp 98059 2= NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO✓ INTERLOCKYEs NO✓ YES ✓ NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 7 [NATURE OF INJURIES SUSPECTED MEDICAL ISSUE 2❑ 3 10❑ P1 ATE 14 AFN5314 sTAr WAv N# 1 D4PU4GX86W505946 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. RLR 1 7 33 12 0 0 VIN#' VIN# RomM TO 34 13 VEH.YEARN MAKE DODG MODEL NITRO STYLE SV VEHICLETOWED0NOOffBLIN WAWkkRS yOES❑ENO✓ DAMAGE IILLJJII tSA1Vi�6 REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ UABILI INSURANCE INSURANCE CO FARMERS 195462186 4 IN EFFECT &POLICY# TOPVEHICLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 6 UNIT 02 MOTOOR Z CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER ❑ DYES✓ H OLD MET PHONE 16 VEHIL❑ 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 INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/ 19 LLIICENS RIVEWS# 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 ❑ ❑21❑ PLATE# KOROKKE TAre WA VIN 1 41 SFRYD4H48GB026197 1 42 22❑ PIR ILER LATE# STATE pLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR 2016 MAKE ACUR MODEL MDX STYLE SV VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 L4❑ DAMAGE YESfj NO✓ YES NO✓ REGISTERED OWNER INFO SIU NO 201 UNION AVE SE RENTON WA 98059 D:2068901288 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE &POINSURGY#E CO ALLSTATE 976 692 085IN �VE""LE ❑ ,J� CITATION# CHARGE i LEGALLY YES N`L J 25 $ =UGENT (PRINT) OFFICER PHONE BADGE OR ID# 77P�1300 26 11498 PART A PAGE 01 OF C7 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE44302 COLLISION REPORT III III III III III 111 1591972 CASE# 24-498 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) NATHAN PATRICIA A (LAST FIRST, ADDRESS&PHONE# D O.B. 201 UNION AVE SE#65 RENTON WA 98059 2062003026 SEX F MMDDYyYv 03 - 01 - 1953 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑ POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX' MMDDYYYY PASSENGER ❑WITNESS❑ UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. 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 01-15-24 12:45 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 1/25/2024 2:10:11 PM BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 8:31 AM TIME POLICE ARRIVED 8:40 AM PART I PAGE IT]OF 5� REPORT NO. EE44302 CASE# 24-498 OF COLLISION 01/15/24 08:28 OF CbLLI510N NARRATIVE 24-498 On 01/15/2024 at approximately 0834 hours, I was dispatched to assist at a possible unknown-if- injury vehicle into a building collision at Leisure Estates, located at 201 Union Ave SE, within the City Limits of Renton, County of King, State of Washington. While en route, Dispatch advised that a black Dodge SUV (Unit#1) had been seen driving erratically through the neighborhood, pulling into multiple driveways, and ultimately hitting a parked car/residence where the vehicle came to a rest. Upon my arrival, 1 contacted the driver and sole occupant of Unit#1. The driver of Unit#1 was the registered owner and identified via DOL photo as Brock, Clifford (DOB 09/06/1947). The driver of Unit #1 stated that prior to the collision, he was traveling southbound on the private way known as "Fir Drive". The driver of Unit#1 stated that he "lost control" of his vehicle in the moments prior to the collision. The driver of Unit#1 also mentioned that he had just been released from the hospital. Based on my initial interaction with the driver of Unit#1, 1 believed this to be a possible medical- related issue as I did not detect any signs of impairment when interacting with the driver of Unit#1. 1 requested through Dispatch that the Renton Regional Fire Authority (RRFA) respond to the scene for evaluation. According to a witness who remained at the scene, identified as Patricia Nathan, Unit#1 appeared to have pulled into the private cul-de-sac, referred to as "Elm CT" at a high rate of speed. Nathan said that Unit#1 struck the side of a residence while it turned from Fir Drive onto Elm CT, subsequently making contact with the north side of a residence; Unit#66. Nathan stated that Unit#1 then abruptly reversed and attempted to get turned around within the small private drive. After reversing, Unit#1 proceeded forward and struck the pillar to a covered carport, also belonging to Unit#66. According to Nathan, Unit#1 eventually lost control and collided into the landscaping of another residence; Unit #117. Unit#1 continued through the landscaping and into another carport pillar belonging to Unit #117, ultimately colliding into Unit#2 which was parked and unoccupied underneath the now damaged carport. The owner of Unit#117 said that there was additional damage to the siding of the house as a result of the contact of Unit#1 and Unit#2. The driver of Unit#1 was evaluated by RRFA at the scene and later transported via ambulance to Valley Medical Center (VMC) for further evaluation. Based on the above statements, 1 believe the driver of Unit#1 (Brock) did not exercise ordinary care while operating a motor vehicle. Even with the significant damages incurred, this collision still had far more potential to cause injury and/or death if the vehicle had collided with a pedestrian in the path of Unit#1. Based on this incident being medically involved, I will be submitting a driver's license retest of Brock through the Washington State Department of Licensing (DOL). Unit#1 had to be impounded from the landscaping/driveway of Unit#117 due to extensive damage. Unit#1 was relocated to Brock's residence at Unit#59. An exchange of information was printed and provided to the driver of Unit#1, the on-duty Manager at Leisure Estates, as well as the property owners at Unit#66 and Unit#117. 1 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 12:37 PM 1/15/2024 Renton, King County, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EE44302 r` POLICE OOL ILIITO REPORT CASE#' 24-498 1 27 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GI NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:2068901288 MIDDLE' 29 LAST NAME NG FIRST NAME SI(J I INITIAL F STREET 30 NEW AnnRF.g 201 UNION AVE SE#117 CITY RENTON ST WA ZIP 980594155 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]Na� YEs N L DRIVER'S STATE SEX M M�DDYBYv 01 TOE - 1961 LICENSE 7 F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 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 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING 4 MOT{7R PEDAL PROPERTY a 7 e DAMAGE THRESHOLD MET PHONE ❑ 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES✓ NO D:4259198507 36 15 ❑ LAST NAME RANDALL FIRST NAME MICHAEL MIDDLE J INITIAL 16 ❑ STREET ❑✓ 201 UNION AVE SE#66 CITY! RENTON ST WA ZIP 980575549 NEW AnnRESR CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTEL 17 ❑ INTERLOCK YES No INTERLOCK YEs NO YEs NO El DRIVER'S STATE SEX M D.O.B 37 18 ❑ LICENSE# MMDDYYY 11 - 26 - 1946 ON DUTY STATUS AIRBAG RESTR, EJECT HELMET INJURY NATURE of INJURIES ❑ 38 USE ICLASS 19 ❑ 39 LICENSE rnr vIN# PLATE# 20 ❑ TRAILER TRAILER El40 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 NOEII El 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 LecALLv 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. MATTHEW NUGENT 01-15-24 12:45 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 11498 O#IL WA0171300 JACOBS 1/25/2024 PAGE F41 OFF 3000-345-013(R 11118) REPORT NO. EE44302 CASE# ' 24-498 DATE AND TIME 01/15/24 08:28 OF COLLISION Vr " PAGE 5 OF 5