HomeMy WebLinkAbout24-7782 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-7782 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 07 - 1-- 2024 0745 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE CARR RD BLOCK NO. e✓ 10700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 240 00 FEET MILES e S ❑ W e 108THAVESE
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2063729091 0 7 30
6� LAST NAME SEFERIAN FIRSTNAME JOEL MIDDLE R 1 1 2 31
INITIAL
STREET ❑✓ 17735 105TH PL SE B302 CITY RENTON ST WA Zlp 98055 z=
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10� PI ATFBit CLY7910 sTATI WAvIN#' JF2SKARC2MH454815
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE ] 9 34
13 2 2021 SUBA FOREST 4H DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO JOEL SEFERIAN 2222075TH STREET CT E BUCKLEY WA 98321 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI VINSURANCE INSURANCE CO STATE FARM 3883915-AOI.47B 4
IN EFFECT &POLICY# 9TOP
VEHICLe
15❑ 5 36
LECALLv YES❑NO❑ CITATION# CHARGE 10 BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4256149557
16 a
LAST NAME HEMPEL FIRST NAME MARK MIDDLE W
INITIAL
17❑ STREET ❑', 606 CHRISTIAN LN SE CITY ORTING ST WA ZIP 983600000 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT t—
SENT MEDICALTRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YES It I NOF YES t l NOF,—/]
19� DCENS STATE WA SEX M MMr C.B. 12 16 _ 1965 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I C67990J TATe WA vIN1i 1FDUF5HTXHDA04651
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2017 MAKE FORD MODEL F550 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO UNITED RENTALS NORTH AMERICA 4001 LEADENHALL RD MOUNT LAUREL NJ 08054 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO AON RISK SERVICES NE INC ISAH1076337A I STOP 5
IN EFFECT
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES NC[:]
25❑ s
7.FF1CJEO-S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HNSON 0505 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE99219
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7782
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.
CO.JOHNSON 07-24-24 03:43 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1
7/25/2024 3:30:20 PM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 7:54 AM TIME POLICE ARRIVED',8:01 AM
PART I PAGE IT]OF 4�
REPORT NO. EE99219 CASE# 24-7782 OF COLLISION
07/24/24 07:45
OF CbLLI510N
NARRATIVE
U1 exits parking lot from south to EB lane #3 (left turn lane) and impacts rear of U2 stopped for
traffic/light
On 07-24-24 at about 0754 hours, I was dispatched to a collision in the vicinity of the intersection of
SE Carr Rd and 108th Ave SE in the City of Renton, County of King, Washington State. There were
no reported injuries and the vehicles had pulled into a commercial parking lot to the southwest of the
intersection. I arrived at about 0801 hours.
The driver of Unit 01 was identified by WA DL and admitted to driving the listed vehicle. The driver
said he was wearing a seatbelt and not injured as a result of the collision. Unit 01 was exiting a
private drive (parking lot) to the south of the 10700 block of SE Carr Rd with the intent to turn right
and enter the left turn lane (lane #3) to turn left at the intersection. The driver said there was a gap in
traffic behind Unit 02 which was stopped so he went forward. The driver said he misjudged the
available space between the vehicles and the passenger side of his vehicle impacted the rear driver
side corner of Unit 02.
The driver of Unit 02 was identified by WA DL and admitted to driving the listed vehicle. The driver
said he was wearing a seatbelt and not injured as a result of the collision. Unit 02 was eastbound in
lane #2 (of 3) of the 10700 block of SE Carr Rd and stopped for traffic that was stopped for a red
traffic signal at the intersection. The driver said that Unit 01 pulled into the roadway and struck the
rear of Unit 02.
1 observed moderate damage to the passenger side of Unit 01. The rear passenger door was
damaged and missing the distinctive plastic trim from the bottom. The driver of Unit 02 directed my
attention to where the collision occurred and I observed the missing trim on the roadway between
lane #2 and #3. There was only minor damage to the driver side rear corner of Unit 01. Unit 01 is a
heavy duty maintenance vehicle with reinforced metal steps mounted to the rear bumper. The
damage to the vehicles corresponded with the information provided by both drivers. Neither vehicle
appeared to need a tow.
The proximate cause of the collision was the driver of Unit 01 failing to recognize the available space
when entering the roadway from a private drive and changing lanes of travel. Were it not for the
actions of the driver of Unit 01, the collision would not have occurred.
No citations or infractions issued. Report for information and insurance.
PAGE 3 OF 4
REPORT NO. EE99219 CASE# 24-7782 DATE AND TIME 07/24/24 07:45
OF COLLISION
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