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HomeMy WebLinkAbout24-4330 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 ❑ ❑ FIRE ❑ CASE$# 24-4330 2 0 4 INTERSTATE CITY STREET RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCALAGENCI WA0171.300 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 0 4 TOTAL#OF OBJECT 28 i TRIBAL 1 03 STRUCK FENCE RESERVATION 2 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION 04 - 20 - 2024 1901 17 ❑.❑ S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SE 192ND ST BLOCK NO. e✓ 19200 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 108THAVESE 0 4 29 MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 4 30 6❑ LAST NAME BARNHILL FIRSTNAME WILLIAM MIDDLE D [1 —ll 31 INITIAL STREET Ell NE 12TH ST CITY RENTON ST WA ZIP 98059 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYES NO�/ INTERLOCK YES NOF,/I YES No�/ 8❑ LDRIVER # STATE WA SEX'M MID LOB 10 1— 26 — 1967 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑ 3 10❑ P1 aT�S� C209425 sTAr� WAurN# 1 FTZF0863WKC07428 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FR.. ro TRLR. TRLR. 3 5 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 34 13 4 1998 FORD F150 /'K DAMAGE YES NO �MEYER 3 5 YES❑ No REGISTERED OWNER INFO KAREN ROGERS 16255 SE 144TH ST RENTON WA 98059 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO EFFECT &POLI IN EFCV# 9TOP veFE CHARGE 1 5 36 LEGAL Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:3607619097 16 a LAST NAME HENRY FIRST NAME SHANNON MIDDLE L INITIAL 17 NEW ADDRE_ 19402 1STREET 08TH AVE SE CITY KENT ST WA ZIP 98031 37 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l NO❑ 19 DRIVER # ❑ ON DUTY STATUS I AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑ 41 21❑ PLA E# BYS3551 TArE WA VIN# 1J8HG58226C363708 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2006 MAKE JEEP MODEL COMMAN STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO ARIC BROWN 4902335TH AVE SE FALL CITY WA 98024 D:3607619097 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# I VEHICLE Yes Nc❑ CITATION# 4A0332257,4AO332257,4AO332257 CHARGE OP MOT VEH W/OUT INSURANCE, GQ, cn v 25 s a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 KEITH PETTY 12809 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE86726 COLLISION REPORT III III III III III 111 1591972 CASE# 24-4330 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' TRAFFIC COLLISION Shannon L Henry (DOB 07/23/1962) was driving a brown Jeep (BYS3551/WA) (V2) heading west on SE 192nd St towing a blue Ford F-150 (C20942S/WA) (V1) that was being controlled by William D Barnhill (DOB 10/26/1967). The two vehicles were attached with a chain connecting them. They were stopped at the intersection of SE 192nd St and 108th Ave SE waiting to turn left onto 108th Ave SE. When the light changed, they proceeded into the intersection and had accelerated too fast for the road conditions. The F-150 was slungshot around pulling the Jeep sideways into the intersection. The F-150 crashed into the fence on the west side of 108th Ave SE and over the retaining wall landing on its side. The cost to repair the metal fence and landscaping is estimated at $10,000. Shannon was unable to produce any verification of insurance. Gene Meyer retrieved the truck from the crash site at the owner's request. "I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct." Electronically signed: K.Petty, Date: 05/14/24at 2232 hours, Place: Renton, King County, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEITH PETTY 04-20-24 11:22 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 6/14/2024 8:29:56 PM BADGE OR ID# 12809 OR]# WA0171300 TIME POLICE DISPATCHED 7:09 PM TIME POLICE ARRIVED 7:01 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT NO. EE86726 r`) POLICE TRAFFIC 1 27 COLLISION REPORT (CASE# 24-4330 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 I_J CYCLE u PEDESTRIAN � OWNER � YEs� NO D:2537409559 MIDDLE.. 29 LAST NAME MARSH FIRST NAME ERIC INITIAL STREET 30 NEW AnDRFSP' 19624 134TH CT SE CITY RENTON ST WA ZIP 98058 6 ❑ CDL GNITION REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]NO� vES N L DRIVER'S STATE I SEX M M�DDYBYv 08 - 20 - 1950 LICENSE 7 F-I ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE GLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9F-I TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIC P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ EHILLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL ❑ 36 STREET 16 NEW AnnRFs.�' CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN 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 ❑ vIN 39 LICENSE # PLATE# rnr 20 ❑ TRAILER' TRAILER ❑ 40 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 LEwGLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv 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. KEITH PETTY 04-20-24 11:22 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 � OR ID# 12809 O#II,WA0171300 APPROVED BY 6114/2024 PAGE�OF 4 3000-345-013(R 11118) REPORT NO. EE86726 CASE# ' 24-4330 DATE AND TIME 04/20/24 19:01 OF COLLISION 4 PAGE 4 OF 4