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HomeMy WebLinkAbout24-11365 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c COLLISION REP FIT 1591971 CASE 24-11365 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING' COUNTY RD PRIVATE WAY INVOLVED 2❑ TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 RESERVATION STRUCK z 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# cawsloN 11 - 01 - 2024 1726 17 =. S H W H OF 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE CARR RD BLOCK NO. e ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 106TH PL SE 0 8 29 MOTOR PEDAL- DAMA THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ElYES N GEO F,/ D:4255298210 0 8 30 6❑ LAST NAME COLEMAN FIRSTNAME JESSICA MIDDLE D 1 1 2 31 INITIAL STREET El12210 SE PETROVITSKY RD L101 CITY RENTON ST WA 2jp, 98058 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES NO 8❑ LDRIVER # STATE WA SEX'F MID .O B 08 - 12 - 1987 1 2 32 9❑ ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10❑ Pi aT�S� CEC5977 sTATe WAvIN# 1 FMDU73E32ZC48369 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM ro TRLR. TRLR. 7 9 33 12 0 0 VIN#' VIN# :: FROM TO VEH.YEAR MAKE FAMODEL STYLE IV HICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 9 34 13 2002 FORD EXPLOR UT DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO JESSICA COLEMAN 12210 SE PETROVITSKYRD L101 RENTON WA 98058 D:4255298210 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VE'CLE CHARGE 1 5 36 LECALLv YES❑NO CITATION# 10 BOTTOM 15❑ TANDING MOTOR pEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE�Ul NIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4256792528 16 a LAST NAME TAN FIRST NAME VIRGINA MIDDLE INITIAL 17❑ STREET ❑', 14300 SE 171ST WAYH10 CITY' MAPLE VALLEY ST WA ZIP 98058 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38 INTERLOCK YEs❑NOR INTERLOCK YEs I I NOF YES t l NO❑ 19 DRIVEW # INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE BWW2922 TATE WA VIN# JTDKN3DU1B5337646 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. TOWED BY Gov HI 44 VEH YEAR 2011 MAKE 7'Oy7' MODEL pRIUS STYLE 4H DAMAGE TOWED NOO✓ BLIN YES NO 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE,IN DAMAGED AREA 4� 3 4 LIABILITY INSURANCE &POINSURGY#E CO PROGRESSIVE 982377907IN STOP 5 VE"LE ❑ ,J� CITATION# CHARGE 25 1oBOTTOM LEGALLY YES N ' a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 SlTIVEN/TAMAIVENA 12812 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF31334 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11365 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. S/TIVENI TAMAIVENA 11-01-24 09:30 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT P.SUMMERS 8887 11/2/2024 4:10:45 PM BADGE OR ID# ! 12812 OR]# WA0171300 TIME POLICE DISPATCHED 5:32 PM TIME POLICE ARRIVED',5:33 PM PART B PAGE IT]OF 4� REPORT NO. EF31334 CASE# 24-11365 F LNa O 11/01/24 17:26 F coy�isI©�ON u NARRATIVE On 11/01/2024, at approximately 1726 hours, while employed as a uniformed Patrol Officer for the City of Renton, I was dispatched to a non-injury accident at SE Carr Rd and 106th Ave PI SE, within the City of Renton, County of King, State of Washington. The Driver of Unit 1 is Coleman, Jessica D (DOB 08-12-1987). Coleman was the driver of a 2002 Ford Explorer with license plate WA/CEC5977. The driver of Unit 2 is Tan, Virginia (DOB 02-10-1988). Tan was the driver of a 2011 Toyota Prius with license plate WA/BWW2922. Unit 2 stated she was traveling eastbound on SE Carr RD in lane 2. Unit 1 was in front of her vehicle at a red light and was also going eastbound on SE Carr Rd. Unit 2 stated that she observed the vehicle trying to reverse. Unit 1 vehicle collided with Unit 2's front bumper, causing minor damage. Unit 2 said that the Unit 1 vehicle was trying to get to lane 1 to go northbound on 106 PL SE. Unit 1 stated that she was in lane two going eastbound on SE Carr RD and needed to travel northbound on 106th PL SE. She said she did not see any vehicle behind her vehicle and attempted to reverse. Unit 1 then said she suddenly hit a vehicle behind her. Unit 1 was not able to provide insurance. Unit 1 was cited for Operating a Motor Vehicle without Liability Insurance (RCW 46.30.020). She understood that she would receive her ticket by mail. My Axon camera was on for this call. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. This report was electronically signed by Officer Si. Tamaivena #12812, November 1st, 2024, at 1830 Renton, WA. PAGE 3 OF 4 REPORT NO. EF31334 CASE#', 24-11365 DATE AND TIME 11/01/24 17:26 OF COLLISION �l yp S� { i bl t �k i • rr k Y�, } 4 t w � t � PAGE 4 OF 4