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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 ti it a, . PAGE 4 OF 4