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HomeMy WebLinkAbout24-9259 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
SASE 24-9259 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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#
COLLISION'. 09 - 1-— 2024 1139 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH STREET BLOCK NO. e✓ 4100 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a UNION AVE NE
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2066186545 0 11
30
6� LAST NAME DEVERA FIRSTNAME NIA MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 563 QUINCYAVE NE CITY RENTON ST WA 2jp, 980594555 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES No YES No
8❑ DRIVERS
# STATE WA SEX'F MMDDYY' 01 - 07 - 2005 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES z❑
3
10[1 PI ATNE 14 CML1884 sTAr WAuN# 5YJ3E1EB9LF628191
5 TRAILER STATE TRAILER STATE
11
3—LATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 7 3 34
13 2020 TESL MODEL 4D DAMAGE YES NO � '` RS YES❑ No✓
REGISTERED OWNER INFO NIA DEVERA 563 QUINCYAVE NE RENTON WA 98059 D:2066186545 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14� LIABILITY INSURANCE INSURANCE CO STATE FARM 4674492-C24.47A
IN EFFECT &POLICY# 9TOP
❑ LEGA LE CHARGE 1 5 36
15 2 srnNoiNG res No CITAnoN# gg0612119 IMPROPER LANE USAGE o aorrom
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT(12 ❑ PEDESTRIAN ❑ ❑ YES,/ No D:2064851873
VEHICLE CYCLE OWNER
16 a
LAST NAME SIMMONS FIRST NAME AMANI ULMER MIDDLE I A
INITIAL
17❑ STREET ❑', 300 VUEMONT PL NE APT A101 CITY RENTON ST WA ZIP 980564505 37
NEW ADDRESS ❑
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'S STATE WA SEX M D.C.B. 02 _ 10 _ 1993 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CDV8447 TAre WA VIN# 1C4RDHAG6FC113772
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE DODG MODEL DURANG STYLE SV VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO AMANI ULMER SIMMONS 300 VUEMONT PL NE APT A 101 RENTON WA 98056 D:2064851873 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE INSUry�—I� &POLICY#E CO GEICO 6076-40-33-41IN GQI
vewcLE CITATION# CHARGE
LEGALLY YES N
25 s � e
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF14465
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9259
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NELSON ANNA C
(LAST FIRST,
ADDRESS&PHONE#
4407 SE 4TH PL RENTON WA 98059 2064069649 SEXi F MMDOYyry 03 - 02 - 1977
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEXI 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.MMDD -❑
YYYY.
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 09-03-24 02:24 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 1 9/12/2024 3:51:58 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 11:41 AM TIME POLICE ARRIVED]11:42 AM
PART I PAGE IT]OF 4�
REPORT NO. EF14465 CASE# 24-9259 OF COLLISION
09/03/24 11:39
OF CbLLI510N
NARRATIVE
24-9259
On 09/03/2024 at approximately 1142 hours, I was dispatched to an unknown-if-injury vehicle
collision at the intersection of NE 4th Street and Union Ave NE, within the City Limits of Renton,
County of King, State of Washington.
Upon my arrival, 1 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 she and her adult passenger were traveling eastbound in about the 4000
block of NE 4th Street and approaching the intersection of Union Ave NE in lane 1 of 3. The driver of
Unit#1 stated that she needed to get into the left lane (lane 2 of 3). The driver of Unit#1 stated that
she believed Unit#2 had already merged into a different lane. The driver of Unit#1 stated that while
making the lane change, Unit#1 and Unit#2 collided in lane 2 of 3 causing moderate damage to the
driver's side bumper, fender, and quarter panel of Unit#1.
The driver of Unit#2 said he was the sole occupant of his vehicle and was also traveling eastbound in
about the 4000 block of NE 4th Street approaching the intersection of NE 4th ST in lane 2 of 3. The
driver of Unit#2 stated he was intending to continue straight when Unit#1 changed lanes from lane 1
of 3 and into lane 2 of 3 which Unit#2 was occupying. The driver of Unit#2 activated his horn prior to
collision but was ultimately unable to avoid the collision and Unit#1 subsequently collided with Unit
#2. Unit#2 suffered significant damage to the front passenger fender and wheel bearing due to the
collision.
An independent witness, identified as Nelson, Anna C (DOB 03/02/1977), remained at the scene.
Nelson confirmed the above statements claiming that Unit#1 changed lanes into Unit#2.
Based on the above statements, 1 determined that the Driver of Unit#1 (Devera) is the proximate
cause for the cause of collision as Devera 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. Devera made
a lane change into Unit#2's lane of travel which had the right of way and was underway. Devera did
not ensure that traffic in lane 2 of 3 was clear of hazard before making the unsafe lane change.
I cited Devera via mail for Improper Lane Usage causing a collision.
Both Unit#1 and Unit#2 required a tow due to extensive damage. Both parties made private
arrangements for a tow truck. 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 2:14 PM 9/3/2024 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO.! EF14465 CASE# ' 24-9259 DATE AND TIME 09/03/24 11:39
OF COLLISION
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PAGE 4 OF 4