HomeMy WebLinkAbout24-2844 ITFF' "POLCERA II I !�� I III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
CASE 24-2844 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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 03 - 1-- 2024 1315 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S RENTON VILLIAGE BLOCK NO. e✓ 700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e TALBOT RD S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2067552947 0 4 30
6� LAST NAME CISLER FIRSTNAME DOUGLAS MIDDLE A 1 2 31
INITIAL
STREET ❑ 726 S 38TH CT CITY RENTON ST WA ZIP 980555894 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 H USEET 2 1 INJURY CLASS 7 I [NATURE OF INJURIES
NECK AND HEAD INJURY z❑
3
10❑ P1 ATNES# BFF0705 sTAr WAu N# KNDPRCA60H7258241
IT STATE TRAILER STATE
11 0 0 PLATE# I PLATE# I I FROM TO
TRLR. TRLR. $ 1 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 $ 34
13 2 2017 KIA SPORTA UT DAMAGE YES NO ✓ YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO USAA 00869 59 86C 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STAIN,DIING 7 6
UNIT U2 VEHIMOTCCLE CYCLE ❑ PEDESTRIAN ❑ OWN A PEDAL RTY [:]EA.
✓ NO OLD MET PHONE
16 a
LAST NAME ECKER FIRST NAME TINA MIDDLE I,l
INITIAL
17❑ STREET ❑', 14438 196TH AVE SE CITY RENTON ST WA ZIP 980597821 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA ]SEX IF D.O.B. 11 03 _ 1970 39
LICENSE# MMDDYY
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE 2 CLASS 5 NECK INJURY ❑
21❑ LICENSE I C61209W TAre WA vlNft 3N6CMOKN3KK701487
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2019 MAKE NISS MODEL NV200 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO UYETA LANDSCAPE AND MAINTENAN 21113143RD AVE SE KENT WA 98042 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO MIDDLESEX INSURANCE 23434IN STOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N 6
25 7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE60143
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2844
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BARBEN JACK G
(LAST FIRST,
ADDRESS&PHONE#
242 STANFORD AVE KENS/NGTON CA 94708 SEX M MMDDYyry 08 - 07 - 1980
PASSENGER WITNESS❑'I UNIT# 3 POST 3 AIRBAG 2 RESTR. 4 EJECT ? HELMET INJURY NATURE OF INJURIES
USE 1 2 CLASS !1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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'
On March 15, 2024, at 1315 hours dispatch requested that I respond to a collision at the intersection
of S Renton Village PI and Talbot Rd S, in the city of Renton, County of King, and State of
Washington.
Upon my arrival I spoke with the driver of unit 1 and he explained he was going northbound on Talbot
Rd S when the collision occurred. As he went underneath underpass, he tried placing his sunglass
on, but failed to notice the red traffic light coming up ahead. When he finally looked up, he locked his
brakes but was unable to bring his vehicle to a complete stop. He struck unit 2's driver side door.
Unit 1 and 2 were heavily damaged and required a tow to be removed from the location.
I then spoke with the driver of unit 3 and he explained he was proceeding through green light and
making a left turn when the collision occurred. He was making a left turn from the 1405 off ramp to
Talbot Rd S. He planned to go southbound on Talbot Rd S.
As the driver of unit 3 proceeded forward, unit 2 was struck by unit 1, which then pushed unit 2 into
unit 3. Unit 3 sustained moderate damage and needed to be towed away as well.
The driver of unit 2 sustained a neck injury and was transported to Valley Medical Center for care.
Later, I spoke with the driver of unit 2 and she provided a similar story as to the driver of unit 3. She
planned on making a left turn from 1405 to Talbot Rd S when the collision occurred. The driver of unit
2 stated that while she proceeded forward, unit 1 ran the red light striking her vehicle. She did not see
the vehicle and was unable to react properly due to time and proximity of unit 1.
I provided all the drivers with an exchange of information.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 03-15-24 03:26 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 311812024 12:04:45 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED'; 1:15 PM TIME POLICE ARRIVED',1:15 PM
PART I PAGE IT]OF 4�
SUPPLEMENTAL REPORT No. EE60143
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-2844
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:2069541026
0 4 29
LAST NAME PEARSON FIRST NAME KEVIN MIDDLE' ',, D
INITIAL
STREET 30
NEW AnDRFSP' 16617 MARINE VIEW DR SW CITY BURIEN ST WA ZIP 981663209
6
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv', 11 TV]
- 1961
7
ON DUTY� STATUS AIRBAG' 1 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE CJH6617 TAr WA VIN# WA17AAF47PA064921
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2023 MAKE AUDI MODELA4 STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vFH1G P FROM TO
DAMAGE YES 'E YES NO
REGISTERED OWNER INFO.THOMAS KENISON 16617 MARINE VIEW DR SW BURIENWA98166 3 5 33
12 SHADE IN DAMAGED AREA
7GQ
j4 FROM TO
LIABILITY INSURANCE INSURANCE CO SAFECOX5070053 IN EFFECT &POLICY# 1EHICLE 34
13LEGALLY YES❑ NO❑ CITATION# CHARGE
STANDING S} 7 6
14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME NII7 aL
❑ 36
ET STRE
16 NEW ETnnR"F] CITY ST ZIP
CDL IGNITION REdUiRED IGNITION 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 ❑ 39
LICENSE rnr VIN#
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE If 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 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEHIcLE 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.
C.CATALAN 03-15-24 03:26 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 12007 O#I,WA0171300 JACOBS 3/18/2024 PAGE F OF 4
3000-345-013(R 11118)
REPORT NO. EE60143 CASE# ' 24-2844 DATE AND TIME 03/15/24 13:15
OF COLLISION
NTS
5, \
I I
...
'Talbof Rd S
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