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HomeMy WebLinkAbout24-8067 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 INTERSTATE ❑ CITY STREET ❑ FIRE ❑ CASE 24-sos7 2 RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION: OS - 1-- 2024 1316 17 ❑. S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 14000 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5 .❑ FEET e S ❑ W e 140TH WAY ❑ � 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El �/No D:2537404159 0 6 30 6� LAST NAME GULBRAA FIRSTNAME SHIRLEY MIDDLE A 1 1 2 31 INITIAL STREET ❑ 33357 20TH AVE S CITY FEDERAL WAY ST I WA 2jp, 980036838 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/ 8❑ DRIVERS E# ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 . EJECT 1 H USE 2 CLASS 6 [NATURE OF INJURIES CT ON NECK FROM SEATBELT z❑ 3 10❑ PI ATE 14 B58278H STATE WA u N# 1 GCCS149488134450 11[-� TRAILER STATE TRAILER STATE 11 4 5 PLATE# PLATE# I I IR.. ro TRLR. TRLR 3 7 33 12 4 5 VIN#j VIN# :: FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34 13 3 2008 CHEV COLOR PK DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO SHIRLEYGULBR,4A 23130 SE 287TH ST MAPLE VALLEY WA 98038 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 4 14 LIABILITY INSURANCE❑ INSURANCE CO FOREOST INSURANCE COMPANYG01281753600 INEFFECT POLICY# TOPVEHICLE 36 LEGALLv res❑NO❑ CITATION# CHARGE <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN 16 a PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069722076 LAST NAME LI FIRST NAME SHEN MIDDLE N INITIAL 17 STREET I❑ s❑' 6567 SE 8TH PL CITY RENTON ST WA ZIP 980595123 4❑ 37 NEW ADDREs 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YES❑No� INTERLOCK YEs❑NOF YES ❑NOF,/ 19 DRIVER # ❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 LICENSE I ❑21❑ PLA E# BNK9206 TATE 41 WA VIN# 1N4AL3AP7GC204396 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2016 MAKE NISS MODEL ALTIMA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO KEHAI LI 6567 SE 8TH PL RENTON WA 98059 VEHICLE NO.2 SHADEDAMAGEbAREA s Cd LIABILITY INSURANCE INSU PORGY#ECO STATE FARM 4953078AO347IN STOP 'E""LE ❑ N J ,J� CITATION# CHARGE 25 io BOTTOM LEGALLY YES =RSE PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12994 WA0171300 PAGE 01 OF PART A 3000-345-159 fR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF01592 COLLISION REPORT III III III III III 111 1591972 CASE# 24-8067 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) ROBERTSON SYDNEYR (IAST FIRST, ADDRESS&PHONE# 19128 112TH AVE NE APT 531 BOTHEL!WA 980110021 SEXi F MSEAT INJURY MDOYyry 09 - O6 - 1996 PASSENGER I�I WITNESS E]'UNIT# 3 POS. 3 AIRBAG 2 RESTR. 4 EJECT ? 1 USE HELMET 2 CLASS LASS NATURE of INJURIES L�!1 '1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX' MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT 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. JAMAAL KEARSE 08-01-24 05:38 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.KORDEL 9676 1 8/2/2024 6:48:20 AM BADGE OR ID# 12994 OR]# ': WA0171300 TIME POLICE DISPATCHED 4:97 Pry TIME POLICE ARRIVED',1:22 Pry PART I PAGE IT]OF 5� TIME REPORT NO. EF01592 CASE# 24-8067 OF COLLISION08/01/24 13:16 NARRATIVE Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State of Washington. This incident was captured on my body worn video camera and in-car cameras. This report is a summary of events that occurred and is not an exact sequencing of events. On 08/01/2024, at approximately 1316 hours I was dispatched to a report of collision with injury at the intersection of 140th Way SE and Maple Valley Highway. Dispatch advised there was a 3 motor vehicle accident. Dispatch later advised that one of the involved parties was injured and requested aid. At approximately 1322 hours I arrived on scene with my FTO, Officer Phillips. I observed 3 cars with significant damage to each of them. One female had what appeared to be minor injuries and I informed her that Renton Fire was coming to evaluate her. I confirmed there were no other complaints of injury requiring immediate medical response at the time of report. While on scene, I was able to collect all involved party's information and independent summary of the events leading up to the collision. The Driver of Unit 1 advised the following. She was driving westbound in lane 1 of 2 on Maple Valley Highway approaching the intersection of 140th Way SE. As she was driving the driver of Unit 2 stopped abruptly. She tried to break but was not able to stop in time causing her to hit the rear bumper of Unit 2 with the front bumper of Unit 1. She advised she did see the light turn red. Her front driver side airbag deployed. The Driver of Unit 2 advised the following. She was driving westbound in lane 1 of 2 on Maple Valley Highway approaching the intersection of 140th Way SE. As she was approaching the light at the intersection, she noticed it turned red and Unit 3 was stopped at the light. She was coming to a stop behind Unit 3 when the driver of Unit 1 hit the rear bumper of Unit 2 with the front bumper of Unit 1. The force of this collision caused Unit 1 to collide with the rear end of Unit 3 with the front end of Unit 2. Airbags did not deploy. The Driver of Unit 3 advised the following. He was driving westbound in lane 1 of 2 on Maple Valley Highway approaching the intersection of 140th Way SE. He was stopped at the light as it had just turned red. While at a stand still at the light Unit 2 hit the rear bumper of Unit 1 with the front bumper of Unit 2. Airbags did not deploy All three vehicles were unable to be driven of the road and had to be towed. Based on the above statements, 1 believe that the driver of Unit#1 (Gulbraa) was the predominant factor for the cause of collision as she failed to provide enough distance to stop approaching a red light and inattention their surrounds. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer J. Kearse #12994 08/01/2024 1637 Hours Renton, King County, Washington PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EF01 5592 r`I POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-8067 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GI NAME 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:2532667045 rFO 8 29 LAST NAME SLEE FIRST NAME AUSTIN MIDDLE'.. P INITIAL STREET 30 NEW AnDRFrtP 2005 185TH PL SE APT T201 CITY BOTHELL ST WA ZIP 980127936 6 ❑ 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO zERLOCK YES❑N0� YEs N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv', 01 - 12 - 1993 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE ARJO805 TAr WA VIN# KNAFX4A88F5281801 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 4 5 VEH.YEAR2015 MAKE KIA MODELFORTE STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vEH1I' E FROM TO DAMAGE YES 'E YES NO REGISTERED OWNER INFOAUSTIN SLEE 3259 S 366TH ST AUBURN WA 98001 J 9 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE INSURANCE CO GEICO 61171i9260 q"i"Olx IN EFFECT I POLICY# 1 EHICLE 34 13 3 LEGALLY YES❑ NO CITATION# CHARGE 0 BOTTUM STANDING } 8 7 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STRE 16 NEW ETETnnR"Fl CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES NO NTERLOCK YES NO 'YES NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE TAT VIN# 39 PLATE# 20 ❑ TRAILER TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ ❑ 41 TRLR TRLR 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 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv 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. JAMAAL KEARSE 08-01-24 05:38 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED BADGE O#I' AP 126 ORID# 12994 WA0171300 APPROVED BY 8212 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO.! EF01592 CASE# ' 24-8067 DATE AND TIME 08/01/24 13:16 OF COLLISION � '�}\�\fig � � �' �'? }� � �y r .{y�• � 3�t:^4�j?vi+k@M.td4 a t v{i t yy a E .at�vr..W"o'e"mr-a0.h'-111, W9,0 PAGE 5 OF 5