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HomeMy WebLinkAbout24-10075 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-10075 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3 HIT 8 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# COLLISION' 09 - 1-- 2024 0908 17 ❑.❑ S 8 W e IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ SOUTH PUGET DRIVE BLOCK NO. e✓ 1600 ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �,❑ FEET e S ❑ W e ROLLING HILLS AVE SE 2 0 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:2134018594 0 11 30 6� LAST NAME GRAY FIRSTNAME WILLIE MIDDLE H 1 1 2 31 INITIAL STREET ❑✓ 1642 LAKE YOUNGS WAY SE CITY RENTON ST WA 2jp, 98058 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO 8❑ LRIIVERCENS # STATE M$ SEX'M MMDD� 10 - 15 1- 1983 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM USEET I IINLJA URY 1 [!!RE OF INJURIES 2❑ 3 10 9❑ P1 ATE 14 PAE1259 STATE MS VIN# JTJHA31 U740039755 TRAILER STATE TRAILER STATE 11 3 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 3 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34 13 2 2004 LEXS RX 350 SV DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO WILLIE GRAY 307 CHURCH ST COMO MS 386192543 D:2134018594 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 2 14 2 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# STOP 5 vewcLE CHARGE 10 BOTTOM 36 LEGALLY YES No clTAnoN# 4A0612136,4A0612136, NO VALID OPER LICENSE WITH 15❑ 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2088186655 16 a LAST NAME MARTIN FIRST NAME NICOLE MIDDLE M INITIAL 17❑ STREET ❑', 1687 MONROE AVE SE CITY RENTON ST WA ZIP 980583811 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 IVER # STATE WA ]SEX IF M D.C.B. 04 22 _ 1985 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CGW0222 TATe WA VIN# 7FARS4H48PE018424 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE ILER# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2023 MAKE HOND MODEL CR-V STYLE SI/ VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO NICOLE MARTIN 1687 MONROE AVE SE RENTON WA 98058 D:2088186655 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE 8 POINSURGY#E CO STATE FARM 230 2460-C26-47CIN 1 STOP 5 VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N J 25 a 7MA R'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HEW NUGENT 11498 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF22196 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10075 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) HOPKINS JHALIA C (LAST FIRST, ADDRESS&PHONE# 1642 LAKE YOUNGS WAY SE RENTON WA 98058 2062764243 SEXi F MMDovyry 10 - 29 - 1988 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELfv1ET INJURY NaruRE of INJURIEs ❑✓ R 1 POS. 3 2 4 1 USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) GRAY WISOM C ADDRESS&PHONE# DOB 1642 LAKE YOUNGS WAY SE RENTON WA 98058 SEX' - F MMDDvvvv SEAT HELMET I INJURY NATURE of INJURIES PASSENGER RV WITNESS UNIT# 1 POS 9 AIRBAG 2 RESTR. 11 EJECT 1 USE CLASS 1 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. MATTHEW NUGENT 09-26-24 07:04 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 101712024 12:38:29 PM BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 9:92 AM TIME POLICE ARRIVED',9:16 AM PART I PAGE IT]0F 5� REPORT NO. EF22196 CASE# 24-10075 OF COLLISION 09/26/24 09:08 OF CbLLI510N NARRATIVE 24-10075 On 09/26/2024 at approximately 0912 hours, I was dispatched to a non-injury and non-blocking vehicle collision near the intersection of South Puget Drive and Rollings Hill Ave SE, within the City Limits of Renton, County of King, State of Washington. Upon my arrival, I confirmed there were no complaints of injury requiring immediate medical response at the time of report. There, I was able to collect each involved party's information and independent summary of the events leading up to the collision. The driver of Unit#1 said he and his two passengers (one adult and one infant) were traveling westbound in about the 1600 block of South Puget Drive and approaching the intersection of Rollings Hill Ave SE in the only lane of travel. The driver of Unit#1 stated that the roadway opened to two lanes near the above intersection and mentioned that he needed to get into the right lane (lane 1 of 2). The driver of Unit#1 stated that he did not realize the vehicle that was behind him (Unit#2) had moved over into lane 1 of 2, after the lanes split, prior to him. The driver of Unit#1 stated that while making the lane change from lane 2 of 2 to lane 1 of 2, Unit#1 and Unit#2 collided causing moderate damage to the passenger side doors of Unit#1. The driver of Unit#1 stated he only had an Identification Card from the state of Mississippi and did not have a driver's license from any other state. The driver of Unit#1 stated he did not have vehicle insurance either. Per a DOL records check, 1 confirmed the driver of Unit#1 was listed as `Not Licensed'. Unit#1 also had expired registration from Mississippi as of July 2024. The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling westbound in about the 1600 block of South Puget Drive approaching the intersection of Rollings Hill Ave SE. The driver of Unit#1 stated that she had moved into the far-right lane (lane 1 of 2) once the lane split at the intersection. The driver of Unit#2 stated she was intending to continue straight when Unit#1 changed lanes from lane 2 of 2 and into lane 1 of 2 which Unit#2 was occupying. The driver of Unit #2 was unable to activate her horn prior to collision and ultimately both Unit#1 and Unit#2 collided. Unit#2 suffered moderate damage to the front driver's side fender due to the collision. Based on the above statements, 1 determined that the Driver of Unit#1 (Gray) is the proximate cause for the collision as Gray violated RCW 46.61.140(1) which states that a vehicle shall be driven as nearly as practicable entirely within a single lane and shall not be moved from such lane until the driver has first ascertained that such movement can be made with safety. Gray made a lane change into Unit#2's lane of travel which had the right of way and was underway. Gray did not ensure that traffic in lane 1 of 2 was clear of hazard before making the unsafe lane change. I cited Gray via mail for Improper Lane Usage causing a collision. Gray was also cited via mail for violating RCW 46.20.015 by Driving without a Valid Operator's License with valid Identification. See citation #4A0612136 for further details. I also issued Gray a warning for Operating a Motor Vehicle without insurance and for expired vehicle registration. See Warning #W24011661 for further details. Both Unit#1 and Unit#2 were able to be driven away without further incident. An exchange of information was provided to all involved parties. 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 by Officer M. Nugent#11498 7:00 PM 9/26/2024 Renton, King County, WA. PAGE 3 OF 5 REPORT NO. EF22196 CASE# 24-10075 OF COLLISION 09/26/24 09:08 OF CbLLI510N NARRATIVE PAGE 4 OF 5 REPORT NO. 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