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Home My WebLink About23-12559 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-12559 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F E: LOCAL AGENCI 4250 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 11 - 01 - 2023 0937 17 ❑.❑ S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ MAPLE VALLEY HWY BLOCK NO. e✓ 1800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 1 29 MOTU '�01 VEHtOR Z CLE CYCCLE. El �ESAGE NHORE✓LD MET PHONE 0 81 30 6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 2 31 INITIAL STREET ❑ CITY ST ZIP 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCK YES NO YES No 8❑ LIRCIENSRE# STATE I SEX u MMDDYY - 1 1 2 32 9 ON DUTY❑ STATUS I AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑ 3 10❑ P1 ATE 14 BRY5700 STATE WA VIN# KNDJN2A26F7118846 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FR.. To TRLR. TRLR 3 7 33 12 3 5 VIN#' VIN#' >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34 13❑2 2015 KIA SOUL DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO NANCYMORRIS 1818 PACIFIC AVE,APT713 EVERETTWA 98201 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICY# 9TOP VENICLE CHARGE 5 36 LEGALLv res❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2537971057 16 a LAST NAME CARDENAS FIRST NAME ANDRES MIDDLE E INITIAL 17 STREET I❑ 1747 CLOVERCREST ST CITY ENUMCLAW ST WA ZIP 980222336 37 NEW ADOREss❑' 18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NOF,/ 19[-] DRIVER'S STATE WA SEX M D.C.B. 12 _ 27 1978 El 39 LICENSE# MMDDYY HELMET {NJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑ ❑21❑ PLATE# BTD9850 TATe WA VIN# 2(BNFLEEKXC6362574 41 `1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2012 MAKE CHEV MODEL EQUINOX STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO ANDRES CARDENAS 1747 CLOVERCREST ST ENUMCLAW WA 98022 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE 8 POINSURGY#E CO PROGRESSIVE 66633151IN STOP VEHICLE CITATION# CHARGE 25 i o BOTTOM LEGALLY YES N� ❑ JAGENCY s a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 26 K.LANE 10008 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE15737 COLLISION REPORT III III III III III 111 1591972 CASE# 23-12559 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' Unit 2 was stopped behind Unit 3 on westbound Maple Valley HWY at a red light in the 1800 blk. Unit 1 was traveling westbound on Maple Valley HWY approaching the red light and Unit 2 and Unit 3. Driver 2 states that the front end of Unit 1 struck the rear end of Unit 2 which forced Unit 2 forward and the front end of Unit 2 struck the rear end of Unit 3. Driver 2 states that Unit 1 then fled the scene. Driver 3 states that they did not see what caused the collision or Unit 1 at all. Unit 2 sustained very minor rear end damage and front-end damage. Unit 3 sustained moderate rear end damage. Driver 2 provided a license plate of Unit 1, describing it as a black Kia type vehicle. He described the driver as an elderly white female. This matched the description of Unit 1 and registered owner. Unit 1 was not located to verify any damage. As the damage was very minimal to the rear end of Unit 2, it is unknown the extent of damage to Unit 1. This also makes confirmation that Unit 1 was involved in the collision difficult as its status and the lack of damage to the rear of Unit 2 may indicate a different cause of the collision. This report is to document the statements and physical evidence of the collision. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. K.LANE 11-02-23 09:39 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT CO.JOHNSON 0505 111212023 5:32:30 PM BADGE OR ID# 10008 OR]# WA0171300 TIME POLICE DISPATCHED 9:39 AM TIME POLICE ARRIVED]9:41 AM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. EE1 55737 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-12559 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- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ D:2066178231 0 8 29 LAST NAME HA FIRST NAME KWANSU MIDDLE INITIAL STREET 30 NEW AnDRFrtP 16201 MEADOW RD APT Al CITY LYNNWOOD ST WA ZIP 1 980876555 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs No NTERLOCK YES�NO� YEs N ✓ DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 03 - 04 - 1986 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE BVZ0587 TAr WA VIN# 4S4WMARD7M3400373 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2021 MAKE SUBA MODELASCENT STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1Ci E FROM TO DAMAGE YES NO ✓ YES NO ✓ REGISTERED OWNER INFO SOLLI CHAE 16201 MEADOW RD APT A 1 LYNNWOODWA98087 J 9 33 12 � SHADE IN DAMAGED AREA 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO USAA 03710 33 920 7102 9 q"i"Olx IN EFFECT &POLICY# 1 VEHICLE 34 13 2 Lecnuv YES NO❑ CITATION# CHARGE 10 BOTTUM STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER RTY YES[—]AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ ET 16 STRETRE "F ' CITY ST ZIP NEW CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO El 17 37 LICENSE# STATE SEX MMDDDYBYY -� II 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of 1NJURIEs 38 USE (CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I 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 VEHICLE 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. K.LANE 11-02-23 09:39 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 10008 O#IL WA0171300 JOHNSON 111212023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO.! EE15737 CASE# ' 23-12559 DATE AND TIME 11/01/23 09:37 OF COLLISION Q ***NOT TO SCALE*** 18C1 blk MAPLE VALLEY H1Y r. PAGE 4 OF 4