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HomeMy WebLinkAbout24-10388 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-10388 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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'. 10 - 1-- 2024 1315 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 3300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES EET e S ❑ W e MONROE AVE NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES ,/NO D:2066641705 0 6 30
6� LAST NAME MARTIN FIRSTNAME ROYAL MIDDLE D 1 1 2 31
INITIAL
STREET ❑✓ 24016 SE 111TH ST CITY I ISSAQUAH ST WA ZIP 98027 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs 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 9❑ P1 aT�S� CHP2834 sTArI WAvIN# 1 FACP41 M6NF139304
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2 1992 FORD MUSTAN DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO AMBER WAITERS 24016 SE 111TH ST ISSAQUAH WA 98027 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� IN EF ITY INSURANCE❑ INSURANCE CO STATE FARM 545 6360-005.47A 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLYYES NO CITATION# 4AO809585 FOLLOW VEHICLE TOO CLOSELY <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES,/ No D.2065510905
VEHICLE CYCLE OWNER
16 a
LAST NAME TESFAY FIRST NAME SOLOMON MIDDLE IR
INITIAL
17❑ STREET �', 15320 33RD AVE S APT S630 CITY SEATAC ST WA Zip 98188 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER #
INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BBA0258 TAre WA VIN# JTDKARFU7Ca3517938
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2016 MAKE TOYT MODEL PRIUS STYLE VEHICLETOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO KIDANE TESFAY 535 QUEEN AVE NE BLDG RENTONWA98056 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 955426774IN 1 STOP
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N
$
7.111CjEo-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. EF23548
COLLISION REPORT III III III III III 111
1591972 CASE# 24-10388
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) JOHANSEN MIRA J
(LAST FIRST,
ADDRESS&PHONE#
22969 NE 26TH Pt SAMMAMISH WA 980748916 SEXi F MMDOYyry 09 - 26 - 2006
PASSENGER WITNESS UNIT# 1 POS 3 AIRBAG 2 RESTR. q EJECT ? HELMET NJURY NATURE OF INJURIES
USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
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.
CO.JOHNSON 10-09-24 08:02 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 10/1112024 2:50:13 PM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 1:24 PM TIME POLICE ARRIVED',4:Y9 PM
PART I PAGE IT]OF 4�
REPORT NO. EF23548 CASE# 24-10388 OF COLLISION
10/04/24 13:15
OF CbLLI510N
NARRATIVE
On 10-04-2024 at about 1324 hours, I was dispatched to Collision in the vicinity of NE 4th St and
Monroe Ave NE in the City of Renton, County of King, Washington State. A King County Sheriff
Deputy located a collision and directed the involved vehicles to move into a nearby parking lot. I
arrived in the area at about 1329 hours.
The driver of Unit 01 was identified by WA IDL (Royal D. Martin 01-09-2007) and admitted to driving
the listed vehicle. The driver said he was wearing his seatbelt and not injured as a result of the
collision. Unit 01 was westbound in lane #2 of the 3300 block of NE 4th St and intended to turn right
onto Monroe Ave NE. The driver of Unit 01 looked to his right in preparation to change lanes into
lane #1. The driver saw Unit 02 to the front and applied their brakes but Unit 01 slid into the rear of
Unit 02 because of old tires. The driver of Unit 01 was unable to provide proof of current/valid liability
insurance. Checks via DOL of Unit 02 returned expired on 09-05-24.
The driver of Unit 02 was identified by WA DL and admitted to driving the listed vehicle. The driver
said he was wearing his seatbelt and not injured as a result of the collision. Unit 02 was westbound
in lane #2 of the 3300 block of NE 4th St. Unit 02 was slowing for other vehicles ahead in lane #2
when they were hit from behind by Unit 01.
I observed moderate damage to the front of Unit 01 and rear of Unit 02. The damage to both vehicles
was consistent with the information provided by both drivers. Neither vehicle required a tow truck.
The proximate cause to the collision was Unit 01 following to closely behind Unit 02. RCW 46.61.145
(Following too closely) states the driver of a motor vehicle shall not follow another vehicle more
closely than is reasonable and prudent, having due regard for the speed of such vehicles and the
traffic upon and the condition of the highway.
I provided the driver of Unit 01 information about youth traffic court.
Notice of Infraction for Following to closely sent to the Renton Municipal Court to mail to Martin.
PAGE 3 OF 4
REPORT NO. EF23548 CASE# ' 24-10388 DATE AND TIME 10/04/24 13:15
OF COLLISION
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