HomeMy WebLinkAbout24-10618 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. EF31956 170
27
COLLISION REP FIT 1591971
SASE 24-10618 2
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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'. 10 - 11 - 2024 0838 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a MONROE AVE NE
1 2 29
UNIT MOTOR
Z PEDAL-
❑ YESAGE NHORE✓LD MET PHONE 0 1 30
6� LAST NAME NONU FIRSTNAME ESETA MIDDLE 1 2 31
INITIAL
STREET ❑ 12909 158TH AVE SE CITY RENTON ST WA 21p 98059 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'F MID
.O B 04 1- 21 - 2006 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CKS8171 sTArI WAurN# 1 FMDK02W88GA00551
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2008 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 4 FORD TAURUS UT DAMAGE YES NO ✓ YYES[:] NO✓
REGISTERED OWNER INFO DA.NONU 12909158THAVE SE RENTON WA 98059 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME 1 77771KING FIRST NAME CHRIS MIDDLE
INITIAL
17❑ STREET ❑' 22626 NE INGLEWOOD HILL RD CITY SAMMAMISH ST' WA ZIP 98074 37
NEW ADDRESS ❑
18E CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALt-T�RANSPORTED ❑ 38
INTERLOCKYES - NOR INTERLOCK YEs I I NoF YES t l NO❑
19 D IVEW #
{NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE 9995999 TAre WA VIN1 4T1B11HK6KU201927
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2019 MAKE TOYT MODEL CAMRY STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO CHRIS KING 22626 NE INGLEWOOD HILL RD SAMMAMISH WA 98074 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#ECO STATEFARM4847421-A26-47IN 1GQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
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. EF31956
COLLISION REPORT III III III III III 111
1591972 CASE# 24-10618
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
PM 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'
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.
C.CATALAN 10-29-24 01:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1013112024 2:35:05 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 8:41 AM TIME POLICE ARRIVED',8:50 AM
PART I PAGE IT]OF 4�
DATE AND
TIME
REPORT NO. EF31956 CASE# 24-10618 OF COLLISION10/11/2408:38
NARRATIVE
On October 11, 2024, at approximately 0838 hours, I was dispatched to a non-injury and non-
blocking vehicle collision at the intersection of NE 4th St and Monroe Ave NE, within the City Limits of
Renton, County of King, State of Washington.
Upon my arrival, 1 confirmed there were no complaints of injury requiring immediate medical response
at the time of report. There, I was able to collect each involved party's information and independent
summary of the events leading up to the collision.
The driver of Unit 2 said he was traveling westbound in about the 3200 block of NE 4th St and
approaching the intersection of Jefferson Ave but in lane 2 of 2. The driver of Unit 2 stated he was
intending to continue straight when Unit 1 changed lanes from lane 1 of 2 and into lane 2 of 2 which
Unit 2 was occupying. Unit 2 was unable to avoid the collision and subsequently collided with Unit 1.
Unit 2 suffered moderate damage to the passenger side doors and rear fender due to the collision.
The driver of Unit 1 did not say much and only nodded her head up and down while the driver of unit
2 explained the situation. 1 asked the driver of unit 1 if she sideswiped unit 2, and she said yes.
Based on the above statements, 1 determined that the Driver of Unit 1 is the proximate cause for the
cause of collision as the driver violated RCW 46.61.140(1) which states that a vehicle shall be driven
as nearly as practicable entirely 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 made a lane
change into Unit 2's lane of travel which had the right of way and was underway. The driver of unit 1
did not ensure that traffic in lane 2 of 2 was clear of hazard before making the unsafe lane change.
Both Unit 1 and Unit 2 were able to be driven away without further incident. An exchange of
information was provided to all 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 10/11/2024 Renton
PAGE 3 OF 4
REPORT NO. EF31956 CASE# 24-10618 DATE AND TIME 10/11/24 08:38
OF COLLISION
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