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Home My WebLink About24-3321 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-3321 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4200 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 04 STRUCK' FENCE RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# COLLISION.. 03 - 1-- 2024 1220 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ 108TH AVE SE BLOCK NO. e✓ 19033 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV a SE 192ND AVE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4069205538 0 9 30 6 LAST NAME VAN NUS FIRST NAME CHLOE MIDDLE R 1 1 2 31 INITIAL STREET ❑ 20 S 10TH ST E CITY MALTA ST MT ZIP 595380000 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 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� CKV1241 sTArI WAurN# JM16J225630127849 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. A'RLR. 1 5 33 12 0 0 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34 13 2 2003 MAZE) PROTE UT DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 942550909 4 LI EFFECT I SUR N# TOPVEHCLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YEs NO 1/ D:6785349192 16 2 LAST NAME ADJETE FIRST NAME KOFF1 MIDDLE I E INITIAL 17❑ STREET ❑', 1016 N 2ND ST CITY' RENTON ST WA ZIP 980575747 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 DRIVER # {NJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE 2 CLASS ❑ 21❑ LICENSE I CGY9294 TAre WA vIN# 5TDZZRFHOKS299312 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2019 MAKE TOYT MODEL HIGHLAN STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI �44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO KOFFIADJETE 1016 N 2ND ST RENTON WA 98057 VEHICLE NO.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU PORGY#E CO STATEFARM 519 5508-A19-47BIN 1 9TOP VE""LE CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES NEI ❑ J s 7CA NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26LAN 12007 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE65040 COLLISION REPORT III III III III III 111 1591972 CASE# 24-3321 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 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' On March 27th, 2024 at 1220 hours, I came across a collision near the intersection of SE 192nd St and 108th Ave SE, in the City of Renton, County of King, WA. I spoke with the driver of unit 2, and he explained he was stopped in the number 1 lane facing southbound when the collision occurred. He was waiting for the traffic traffic light to turn green. As he waited, he heard screeching tires from behind, and then he flet the impact. He was struck by unit 1 from behind. He believes unit 1 was speeding, causing the collision. I then spoke with the driver of unit 1, and they stated they were unsure of their speed when the collision occurred, but they were not speeding. They applied the brakes, but the vehicle slid into unit 2 as they drove southbound. After unit 1 struck unit 2 from behind, unit 1 rolled into a metal railing belonging to the city of Renton. The railing was bent, but not completely removed from the ground. Unit 1 also rolled into a fence belonging to 19033 108th Ave SE. Unit 2 sustained moderate damage, but was drivable. Unit 2 sustained heavy damage to the front and needed to be towed away by Bankers Towing. An exchange of information was given to all the involved parties. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.CATALAN 03-27-24 01:56 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 4/3/2024 5:52:16 PM BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 12:20 PM TIME POLICE ARRIVED 12:20 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. EE655040 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-3321 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- �`"'j PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO D:4254307500 LAST NAME : CITY OF RENTON FIRST NAME MIDDLE.. 29 INITIAL STREET 30 NEW AnnRFSP' 1055 S GRADY WAY CITY RENTON ST WA ZIP 98055 6 II 1 31 CDL GNITItN REQUIRED GNITION PRESENT MEDEC INTERLOCK YEsNo zERLOCK YES❑N0� T DRIVER'S STATE I SEX U M��DYSYv' —� 2 LICENSE 7F-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 P 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:2066931433 36 15 ❑ LAST NAME NANDULE FIRST NAME '. RUKIA HUSSEIN MIDDLE N INITIAL I 16 ❑ STREET ❑; 19033 108TH AVE SE CITY, RENTON ST' WA ZIP 98058 NEW AnnRFSR CDL IGNITION RE'OUIRED IGNITION PRESENT MEDICALTANSPGRTED 17 ❑ INTERLOCK YES NO INTERLOCK YEs NC7 YEs No ElDRIVER'S STATE SEX F D.O.B 37 18 ❑ LICENSE# MMDDYYY 03 - 05 - 1980 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# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE MODEL STYLE 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 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. C.CATALAN 03-27-24 01:56 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12007 O#IL WA0171300 JACOBS 4/3/2024 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. EE65040 CASE# ' 24-3321 DATE AND TIME 03/27/24 12:20 OF COLLISION y �A rF PAGE 4 OF 4