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Home My WebLink About24-5055 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 24-5055 z INTERSTATE ❑ CITY STREET ❑ FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER VFHIC;I F ❑ LOCAL AGENCI 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK NO RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION'. 05 - 1-- 2024 1411 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 68 RAINIER AVE S BLOCK e✓ 60 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 6 A❑ 100 00 FMILES EET e S ❑ E e AIRPORT WAY 0 1 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES No ,/ D:2068530385 1 9 30 6❑ LAST NAME ATKINS FIRSTNAME MARIO MIDDLE D 1 2 31 INITIAL STREET ❑, 6920 S 123RD ST,#K225 CITY SEATTLE ST WA ZIP, 98178 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS' AIRBAG 2 RESTR 9 EJECT 1 H U EETI I INJURY [NATURE OF CLASS ju LEFTARMNJURIEs z❑ 3 10 9❑ Pi AT 14 DV13450 STATE WA VIN# 1 HGCR3F85DA015693 IT STATE TRAILER STATE 11 0 0 PLATE# PLATE# ROM ro TRLR. TRLR. 3 5 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 ] 34 13 9 2013 HOND ACCOR SD DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO USAA 04759 62 81G 7102 7 4 INEFFECT I SUR N# TOPVEHICLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ,/ D:2066188320 16 a LAST NAME BARR FIRST NAME CRISTINA MIDDLE IS INITIAL 17 NEW ADDRE— 4631 S RASTREET YMOND PL CITY l SEATTLE ST' WA ZIP 98118 37 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19� D IVE INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS ❑ ❑ILICENSE 21❑ PLA E# ARD2451 TATe WA VIN# 41 JTDKDT636E1062266 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GI VEH YEAR 2014 MAKE 7'Oy7' MODEL pRIUS STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO,/ 44 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE &POINSURGY#E CO CONNECT BX11066250IN I 9TOP VEHICLE YES[:] N C[:] CITATION# CHARGE i o BOTTOM LEGALLY 25 $ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 SULIASI TAMAIVENA 12788 WA0171300 PAGE 01 OF PART A 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE80514 COLLISION REPORT III III III III III 111 1591972 CASE# 24-5055 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) RAMEY KAYL (I.P.ST FIRST, ADDRESS&PHONE# 51228 S HOLLY ST SEATTLE WA 98118 9999999999 SEX i U MMDOYyry {� SEAT ' HELMET INJURY NATURE of INJURIES PASSENGER L�WITNESS❑ UNIT# 2 POS 8 AIRBAG 2 RESTR. 3 EJECT I USE CLASS 6 BACK PAIN NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O SEXI E4 MMDDYYYV PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&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. SULIASI TAMAIVENA 05-12-24 06:36 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 5/26/2024 9:46:56 AM BADGE OR ID# 12788 ORI# WA0171300 TIME POLICE DISPATCHED; 2:13 PM TIME POLICE ARRIVED:2:25 PM PART Ei PAGE IT]OF REPORT NO. EE80514 CASE# 24-5055 OF COLLISION 05/12/24 14:11 OF CbLLI510N NARRATIVE On 05/12/2024, at approximately 1416 hours, I was dispatched to an accident with injuries at STARBUCKS, located at 68 RAINIER AVE S in the City of Renton, County of King, State of Washington. The dispatch advised that the accident occurred at Starbucks' drive-through, and an involved party was requesting aid for back pain. I spoke with Unit#1, who stated he was at fault. He advised that he was having a seizure and tried to slam on his brake, but because his feet were big, he accidentally stepped on the gas, causing him to accelerate and hit Unit#3 in the rear. His vehicle had front bumper damages and was still drivable. However, a Medic was called to the scene and stated his blood pressure was extremely high and that he would be transported to Valley Medical for further evaluation. His vehicle was parked at the Starbucks parking lot at his request. I spoke with Unit#3, who advised that she was struck in the rear while waiting in line at the Starbucks drive-through. She claimed that her head and neck were hurting from the impact. Fire arrived on the scene and advised that she was clear but would feel soar for a while. Her vehicle had rear damages and minor front bumper damages due to Unit#1's initial hit, causing her to move forward and hit Unit #2 from the rear. The vehicle is still drivable. She was cleared to drive home. Unit#2 advised that she was also waiting in the Starbucks line when Unit#3 struck her from the rear. I observed minor damages to the rear bumper of the vehicle. She was not injured, but her passenger, Kay, was experiencing back pain from the impact. She was also checked by fire and cleared. The vehicle was still drivable, and she was cleared to drive. An Exchange of information form was given to all parties. Photos were taken and will be uploaded to evidence. No signs of DUI from Unit#1 **** AUTO-POPULATED SECTION **** THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER": Location Character: STARBUCKS DRIVE THROUGH **** END OF AUTO-POPULATED SECTION **** PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EE80514 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-5055 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 5 � UNIT# 3 VEHICLE tSJ CYCLE _) PEDESTRIAN � OWNER � YES NO D:2063870862 1 9 29 LAST NAME BRENT FIRST NAME RENEE MIDDLE' ',, L INITIAL STREET 30 ❑ NEW AnDRFSP' 6120 S KEPPLER ST CITY SEATTLE ST WA ZIP 98118 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31 INTERLOCK YES NO NTERLOCK YES❑N0� vES N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 11 - 12 - 1957 7 HELMET I INJURY' NATURE OF INJURIES ON DUTY STATUS AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 7 PAIN ON HEAD AND NECK 8 ❑ 1 32 LICENSE CGH4489 TAT WA VIN 19XFC1F34KE214847 PLATE# 9 TRAILER TRAILER 191 PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.It VIN.#. 11 0 0 VEH.YEAR2019 MAKE HOND MODEL CIVIC STYLE SD I VEHICLE TOWE E T SABLIN TOWED BY anvi vEH1O FROM TO DAMAGE YES 'E YES NO REGISTERED OWNER INFO OWNED BY DRIVER ] 3 33 12 � SHADE IN DAMAGED AREA j FROM TO LIABILITY INSURANCE INSURANCE CO USAA 056888077 RTOp IN EFFECT &POLICY# vewcLe 10 BOTTOM 34 9 ❑ ❑ CITATION# CHARGE 13 �Ecnuv YES NO gg�@ STANDING } l:9 7 14 ❑ UNIT# Vd I RE O CYCLE � OWNER YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME INITIAL 36 MIDDLE ❑ STREET 16 NEW Aa "F CITY ST ZIP CDL IGNITION REDUIRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK 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 LEHIcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM Lec E 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. SULIASI TAMAIVENA 05-12-24 06:36 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26F7 OI BADGE 12788 O#I,WA0171300 SCOTT 5/26/2024 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EE80514 CASE# ' 24-5055 DATE AND TIME 05/12/24 14:11 OF COLLISION xt t � Ilu4•,x. L. �S y PAGE 5 OF 5