HomeMy WebLinkAbout24-4283 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-4283 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
COLLISION'. 04 - 19 - 2024 1430 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 1700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2533142611 0 11
30
6� LAST NAME CANNON FIRSTNAME DENISE MIDDLE 1 2 31
INITIAL
STREET ❑✓ 26305 242ND AVE SE CITY MAPLE VALLEY ST WA 2jp, 980387106 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BYH7374 sTArI WAurN# 5TDDBRCH7MS521608
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 8 4 33
12 4 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE $ 4 34
13 2 2021 TOYT HIC�HLA 4H DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO DENISE CANNON 26305242ND AVE SE MAPLE VALLEY WA 98038 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 904548233 3 4
IN EFFECT &POLICY# STOP
VEHICLE CHARGE 5 36
LEGALLY
Ye6❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ RO 4254994349
16 a
LAST NAME DEAN FIRST NAME JOHN MIDDLE I P
INITIAL
17❑ STREET ❑', 17700 151 ST AVE SE APT 8F CITY RENTON ST WA ZIP 980589078 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 D IVE
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE DV10449 TAre WA VIN# 5TFJC5D86NX009353
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
TOWED BY Gov H 44
VEH YEAR 2022 MAKE 7'Oy7' MODEL TUNDRA STYLE PK DAMAGE TOWED NOO✓ BLIN YES
N.7
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 0199177477102IN 1ULlliKOTlTlfll;0-
7.111CjEo-SVEHICLE ❑ ,.I—I CITATION# CHARGELEGALLY YES N`LJ25 NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26HNSON 0505 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE70800
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4283
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PRIETO CANNON CAYLEE R
(LAST FIRST,
ADDRESS&PHONE#
26305 242ND AVE SE MAPLE VALLEY WA 98038 SEXi F MMDovyry 02 - 01 - 2017
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 POS. 7 2 10 1 USE CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) PRIETO CANNON MICHAEL I
ADDRESS&PHONE# D O B
26305 242ND AVE SE MAPLE VALLEY WA 98038 SEX M MMDDvvvv 08 _ 01 _ 2014
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 1 POS. 9 AIRBAG 2 RESTR. 10 EJECT 1 USE CLASS 1
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.
CO.JOHNSON 04-19-24 03:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 4/23/2024 6:08:25 PM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED', 2:36 PM TIME POLICE ARRIVED',3:01 PM
PART I PAGE IT]OF 4❑
REPORT NO. EE70800 CASE# 24-4283 OF COLLISION
04/19/24 14:30
OF CbLLI510N
NARRATIVE
U2 SB MVH lane #3; U1 exit NB 1-405 to SB MVH changed lanes into U2
On 04-19-2024 at about 1436 hours, I was dispatched to a collision in the 1700 block of Maple Valley
Highway in the City of Renton, County of King, Washington State. Dispatch advised there was a
collision in the area and the vehicles were moving into the parking lot of the community center. I
arrived in the area at about 1501 hours.
The driver of Unit 01 was identified by WA DL and admitted to driving the listed vehicle. The driver
said she was wearing a seatbelt and not injured as a result of the collision. Unit 01 was northbound
on Interstate 405 and exited to southbound Maple Valley Highway (SR169). After the offramp
merges to southbound Maple Valley Highway, Unit 01 changed lanes to the left and collided with Unit
02. The driver of Unit 01 said she did not see Unit 02 in the far left lane.
The driver of Unit 02 was identified by WA DL and admitted to driving the listed vehicle. The driver
said he was wearing a seatbelt and not injured as a result of the collision. Unit 02 was southbound
on on Interstate 405 and exited to southbound Sunset Blvd N with the intent to go southbound on
Maple Valley Highway (SR169). Unit 02 continued onto Maple Valley Highway in lane #3 (of 4) when
Unit 01 changed lanes into lane #3 and collided with Unit 02.
1 observed moderate damage to the driver side front door of Unit 01 and very minor damage to the
passenger side front bumper and front tire rim of Unit 02. The damage to both vehicles was
consistent with the information provided by both drivers.
The proximate cause of the collision was Unit 01 failing to yield the right of way to Unit 02 while
changing lanes. RCW 46.61.140 indicates a vehicle shall be driven as nearly as practicable within a
single lane and shall not be moved from such lane until the driver has first ascertained that such
movement can be made with safety. The driver of Unit 01 failed to make sure the other lanes of
travel where clear of other vehicles. Were it not for the actions of the driver of Unit 01, the collision
would not have occurred.
No infractions or citations issue. Report for information and insurance purposes.
PAGE 3 OF 4
REPORT NO. EE70800 CASE# ' 24-4283 DATE AND TIME 04/19/24 14:30
OF COLLISION
N
try �
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