HomeMy WebLinkAbout24-4313 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-4313 z
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 N E IN CITY# ❑
COLLISION'. 04 - 1-- 2024 1110 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY SE BLOCK NO. e✓ 15000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:7146106895 0 11
30
6� LAST NAME NDERI FIRSTNAME PERPETUA MIDDLE W 1 1 2 31
INITIAL
STREET ❑✓ 15205 140TH WAY SE#B304 CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ PI ATE 14 CCB0341 STATE WA u N# 1 HGCP2F4XCA182210
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TREK. TRLR. 5 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR 2012 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 HOND ACCOR SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
4 3 4
14 INSURANCE INSURANCE CO COUNTRY PERFERED INSURANCE COMPANY PA4178972
IN EFFECT
IN EFFEE CT &POLICY# STOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4259416960
16 a
LAST NAME MAHAN FIRST NAME RILEY MIDDLE L
INITIAL
17❑ NEW STREETR 7629 19
7 4TH ST CT E CITY SPANAWAY ST WA ZIP 98378 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. 03 _ 29 _ 1996 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE ❑21❑ PLA E# CEP6552 TATE 41
WA VIN# 5J8TB18227A802199 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2007 MAKE /a C(fR MODEL MDX STYLE UT VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO pROGRESSIVE 937348707IN STOP 5
'E""LE ❑ N`L J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
TIM CUMMING 11488 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE75204
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4313
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PHILLIPS CLAIRE M
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
7629 194TH ST CT E SPANAWAY WA 98387 2069490028 SEXi F MMDOYyry 01 - 15 - 2000
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 4 1 USE 2 CLASS 1
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O 8
SEX MMDDYYYV
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R 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.
TIM CUMMING 04-20-24 12:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 51812024 10:47:51 AM
BADGE OR ID# 11488 ORI#' WA0171300 TIME POLICE DISPATCHED; 11:14 AM TIME POLICE ARRIVED 11:22 AM
PART Ei PAGE IT]OF 4]
REPORT NO. EE75204 CASE# 24-4313 OF COLLISION
04/20/24 11:10
OF CbLLI510N
NARRATIVE
24-4313
On 04/20/2024 at approximately 1114 hours, I was working as a Police Officer for the city of Renton.
While I was working, I was dispatched to a collision with unknown details at the intersection of 140th
Way SE and Maple Valley Highway, in the City of Renton, the County of King, State of Washington.
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized. My involvement in this incident was captured
on my department issued Axon body camera. For exact statements made during my investigation
please see my Axon camera footage.
According to the notes in the call, just south of the location there was a two-vehicle collision and it
was unknown if there were injures. As I drove to the location, the call was updated to a non-blocking
collision with unknown injuries. The vehicles pulled off onto the shoulder of the roadway. The first
vehicle was described as a gray Honda with a Washington license plate of CCB0341 and the second
vehicle was described as a gray Acura RDX with a Washington license plate of CEP6552.
Both plates were run through a WACIC/NCIC/DOL records check. According to the returns, the gray
Honda was a gray 2012 Honda Accord 4 door sedan (WA LIC# CCB0341). The Accord was
registered to a Perpetua W Nderi (DOB 06/06/1984). According to the returns, the gray Acura RDX
was a gray 2007 Acura RDX SUV (WA LIC# CEP6552). The RDX was registered to a Riley L Mahan
(DOB 03/29/1996). This information was later used to run each party. Both parties were clear and
had a valid driver's license. I used their DOL photo to confirm their identities. I later learned that the
Acura had a passenger who was identified as Claire M Phillips (DOB 01/15/2000). I used Phillips's
DOL photo to confirm her identity.
For the duration of this case, the Accord will be identified as Unit 1 and the Acura will be identified as
Unit 2. The registered owner of each vehicle was the driver of their vehicle.
I arrived on scene and met with all the parties. I asked them to tell me what happened. Nderi and
Mahan each told me a consistent story.
Unit 1 was traveling south on 140th Way SE ahead of Unit 2. Unit 1 was traveling in the outside lane
and Unit 2 was in the middle lane. Unit 1 suddenly swerved into the lane Unit 2 was traveling in and
Unit 2 collided with the driver's side of Unit 1. The swerve was described as a U-Turn.
The damage to each vehicle was consistent with the statements made by the involved parties. Unit 1
had damage to her driver's side, mainly on the rear door. Unit 2 had damage on the front corner on
the driver's side. Unit 1's airbags deployed.
Renton Fire was called to the scene and they provided medical attention to Nderi. They determined
that no medical attention was needed. The other involved parties declined medical attention as well.
When asked why she suddenly turned into the other lane, Nderi told me that she suddenly got dizzy
and lost control of the vehicle and the vehicle swerved.
Nderi stated that she was not under the influence of any alcohol or narcotics. I did not see any
indication of intoxication.
Photos were taken of the two vehicles and uploaded to evidence.com.
Each party provided me with their driver's license, insurance, and their registration.
I provided each party with an exchange of information form which included my name and the case
number.
There is no further information available at this time.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by T. Cumming #11488 on 04/20/2024 @ 1218 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EE75204 CASE# ' 24-4313 DATE AND TIME 04/20/24 11:10
OF COLLISION
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