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HomeMy WebLinkAbout23-13430 ouCE OF ASHINGcN I� I �I) , II� I I I (III I�I I) SUPPLEMENTALREPORT NO. EE23193 1 8 27
COLLISION REPOFIT 1591971
SASE# 23-13430 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ STOLE F ❑ LOCAL AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 6 0 28
s TRIBAL UNITS 03 STRUCK'
RESERVATION
z
3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E CITY# ❑
cowsloN 11 - 22 - 2023 0745 17 ❑.= S IN 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
ABERDENEN AVE NE
e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 27TH ST
0 4 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD MET PHONE 0 1 30
6� LAST NAME BITA FIRSTNAME VLAS MIDDLE N 1 2 31
INITIAL
STREET ❑ 12210 SE PETROVITSKY RD APT C CITy RENTON ST WA 2jp' 980586658 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs No YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CGT2469 sTArI WAurN# JHMFA36298S026872
10 PI ATE#
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR $ 7 33
12 3 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE
D Civ/C EIEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 AMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO VLASBITA12210SEPETROVITSKYRDAPTC RENTONWA98058 D:4255477726 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO eq�T3 4
IN EFFECT &POLICY# 9TOP
VE— CHARGE 5 36
LEGALLY Yes❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:4258304484
16 a
LAST NAME LAM FIRST NAME CAO MIDDLE I V
INITIAL
17❑ STREET ❑', 2030 GLENNWOOD AVE NE CITY RENTON ST WA ZIP 980562307 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LDI IVEW # STATE WA SEX M M D.C.B. 08 _ O6 _ 1947 0 39
HELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I W4184A TAre WA VIN# 5FNYF4H96C8044781
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2012 MAKE HOND MODEL PILOT STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KIMBERLEY LAM 2030 GLENNWOOD AVE NERENTONWA98056 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. I �VE""LE
❑ ,J� CITATION# CHARGE i o LEGALLYYES N`L J25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
N 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE23193
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13430
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'
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.
M.LEVERTON 11-21-24 02:50 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 11/25/2023 2:30:05 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 7:45 AM TIME POLICE ARRIVED',8:01 AM
PART I PAGE IT]OF 6�
REPORT NO. EE23193 CASE# 23-13430 OF COLLISION
11/22/23 07:45
OF CbLLI510N
NARRATIVE
3/blk sedan eb stop slv suv/2 wb slv sedan/1 It nb to wb
RTF
Within the city limits of Renton/King/WA I responded to a 3 car crash at the intersection of Aberdeen
Ave NE at NE 27th St.
I contacted the driver of unit 1 who told me he stopped at the 4 way stop sign intersection from the
south to turn left/west when he was hit by unit 2 which pushed him into unit 3 who was stopped. He
did not complain of injury and did not require a tow truck for damages. (Romanian Language barrier)
I contacted the (son) of unit 2/ as the driver (dad) did not speak English. Son told me dad was
westbound and after stopping, unit 1 rear ended him in the tow hitch causing no damage. He did not
complain of injury. A quick glance at the damage to unit 2 revealed some damage on the left 1/4
panel, and nothing at the hitch. However, I had not yet walked the block away to unit 1 vehicle
damage. (Unknown Language barrier)
I contacted the driver of unit 3 who told me he was stopped facing east when unit 1-2 crashed and
unit 1 hit the side of his front left fender. He did not complain of injury and damages did not require a
tow truck.
I walked over to look at damages on unit 1. He had damage on both sides of his front bumper and
nothing obvious from striking a hitch near the middle of his bumper. Another unknown male arrived
and helped translate. He told me that unit 1 while making his left turn was hit by unit 2 more near the
front driver side of unit 2. 1 walked over and looked at the damage on unit 2 which had what
appeared to be fresh damage at the driver side front fender. Unit 1 vehicle had matching paint
transfer on his driver side front bumper where he contacted unit 3. Unit 3 had matching paint transfer
from unit 1.
Son of unit 2 showed me a picture of a piece of plastic behind unit 2 at point of rest (POR) and
insisted that unit 1 rear-ended his dad/unit 2. 1 explained that the physics did not add up as the
collision between unit 2 and 3 was in close proximity to the intersection/immediate to the stop bar. In
order for unit 1 to have rear ended unit 2, unit 2 would have been clear of the west side stop bar, and
with no damage to the center of unit 1, this was not consistent with the immediate angular momentum
for unit 2-1 point of impact (POI)-departure to unit 2-3 collision.
If unit 1 had made the left turn and hit unit 2 in the rear tow hitch, unit 2 would have likely impacted
unit 3, as this would have looked similar to a PIT technique and unit 1 most likely would have
continued at a NW attitude without hitting unit 3. Also the angle required for unit 1 to have hit unit 2 in
the hitch with his right side bumper would have been extreme and again likely caused unit 2 to hit unit
3.
Unit 2 dad did not provide any type of statement to me, only his son. Unit 3 could not provide
additional information other than unit 2/1 collided in the intersection and unit 1 contacted his car. Unit
1 provide information initially with language barrier, then with more accurate translation.
Unit 2 son was emphatic ref his version of the collision and unit 3 provided limited information.
Overall the damages to any vehicle was minor/without tow trucks and with no other witnesses to
corroborate the event this will be for insurance/information only.
To clarify, I believe unit 1 came to a full stop on Aberdeen Ave NE from the south. During his
PAGE 3 OF 6
REPORT NO. EE23193 CASE# 23-13430 OF COLLISION
11/22/23 07:45
OF CbLLI510N
NARRATIVE
westbound/left turn and while lawful upon the roadway, I believe unit 2 ran the stop sign from the east
and hit unit 1. This contact forced unit 1 into unit 3.
1 don't believe, based on my training and experience, that unit 1 rear-ended unit 2. There was no
evidence of this type of contact. I don't believe unit 1 had any causation reference the collision
between him and unit 2.
Unit 3 was stopped on NE 27th St waiting to proceed, lawful upon the road when the initial collision
between unit 1 and unit 2 caused unit 1 to contact unit 3.
Unit 2 was the causation of this 3 car collision.
Revised 11/21/2024 It was brought to my attention that I had mislabeled some of the vehicles in my
narrative and made the above corrections and additional statements.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 11/21/2024
PAGE 4 OF 6
SUPPLEMENTAL REPORT No. EE23193
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-13430
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 DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO
D:2067188406
] OF 8 29
LAST NAME GRIGGS FIRST NAME JASON MIDDLE' ',, E r:j INITIAL
STREET 30
NEW AnDRFrtP 2224 NE 27TH ST CITY RENTON ST WA ZIP 980562235
6
CDL IONITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31
INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 04 TV]
- 1977
7
ON DUTYl STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE 683NJW TAr WA VIN# WVWTH63B12P070090
PLATE#
9 2] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2002 MAKE VOLK I MODELPAS4D STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vFH11' FROM TO
DAMAGE YES 'E YES NO
REGISTERED OWNER INFOJASON GRIGGS 2224 NE 27TH ST RENTON WA 980562235 D:2067188406 J 9 33
12 SHADE IN DAMAGED AREA
7GQ
j4 FROM TO
LIABILITY INSURANCE INSURANCE CO USAA 011015801C IN EFFECT &POLICY# 1EwcLE 34
13LEGALLY YES NO❑ CITATION# CHARGE
STANDING S} 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME NII7 aL
❑ 35
STREET"[—]
16 NEW nnR CITY ST ZIP
CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES No INTERLOCK YEs NO YEs NO El
17 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE (CLASS
19 ❑ 39
LICENSE rnr vIN#
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
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 LEHIcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LEGALLv
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.
X LEVERTON 11-21-24 02:50 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
25 ORID# 2517 O#I',WA0171300 JACOBS 11125/202 PAGE 5 OF 6
3000-345-013 fR 11t18)
REPORT NO. EE23193 CASE# ' 23-13430 DATE AND TIME 11/22/23 07:45
OF COLLISION
i
3
as
F'
i
PAGE 6 OF 6