No preview available
HomeMy WebLinkAbout24-11268 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c COLLISION REP FIT 1591971 SASE 24-11268 2 INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 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 1031 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BRONSON WAY NE BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ VV e NE 3RD ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO F,/ I D:5416466672 0 11 30 6� LAST NAME NCUBE FIRSTNAME SINDISO MIDDLE N 1 1 2 31 INITIAL STREET ❑ 1310 COVINA AVE CITY MEDFORD ST OR 7jp, 97504 z� NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES NO ❑ DRIVER'S STATE OR SEX'M MDMDD� 02 - 14 1- 1975 1 2 32 8 LICENSE# 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 D. H USEET 2 CLASS 1 I INJURY NATURE OF INJURIES z❑ 3 10[1P1 ATNES# YAJW548 sTAr OR vN# 4V4NC9EH3PN615370 5 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO FT -R TPILF1 1 5 33 12 2 5 VIN#j VIN# FROM TO VEH.YEAR 2023 VOLV 240 SE MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34 13 DAMAGE YES NO YES❑ NO✓ REGISTERED OWNER INFO SINDISO NCUBE 1310 COVINA AVE MEDFORD OR 97504 D:5416466672 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO PROTECTIVE INSURANCEB-13653 3 4 IN EFFECT &POLICY# 9TOP VEwcLE 5 36 Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDIN LEGALLvG 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064768825 16 a LAST NAME KELLEY FIRST NAME NEVAEH MIDDLE I C INITIAL 17❑ STREET ❑', 300 VUEMONT PL NE APT P201 CITY RENTON ST WA ZIP 980564544 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 DRIVER'S STATE WA SEX F D.C... 08 _ 27 2005 El 39 LICENSE# MMDDYY HELMET {NJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑ 21❑ LICENSE I CND7388 TAre WA vIN# 19XFC2F59GE215216 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. IN#. 43 RLR ' VEH YEAR 2016 MAKE HOND MODEL CIVIC STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO YES NO✓ REGISTERED OWNER INFO NEVAEH KELLEY 300 VUEMONT PL NE APT P201 RENTONWA98056 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO PROGRESSIVE 981123307IN 1UR vE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N 25 7CA NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26LAN 12007 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF34658 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11268 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MCGARY NEKOLE C (LAST FIRST, ADDRESS&PHONE# D O.B. ' 11808 SE 172ND LN APT N301 RENTON WA 980585994 2063192706 SEXi F MMDOYyry 08 - 31 - 1980 PASSENGER Z WITNESS UNIT# 2 POS 3 AIRBAG j 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES USE 2 'CLASS '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 R 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. C.CATALAN 11-06-24 12:11 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE CO.JOHNSON 0505 1 1111212024 2:17:07 PM BADGE OR ID# 12007 OR]# WA0171300 TIME POLICE DISPATCHED 10:33 AM TIME POLICE ARRIVED',10:34 AM PART I PAGE IT]OF REPORT NO. EF34658 CASE# 24-11268 OF COLLISION 10/30/24 10:31 OF CbLLI510N NARRATIVE On November 6, 2024 at approximately 1031 hours, I was dispatched to a non-injury and non- blocking vehicle collision at the intersection of N 3rd Street and Bronson Way NE, within the City Limits of Renton, County of King, State of Washington. 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 2 said she was accompanied by her front passenger. The driver of unit 2 said she was traveling northbound in about the 200 block of Bronson Way NE and approaching the entrance Kaiser Permanente. The driver of Unit 2 stated he was intending to continue straight when Unit 1 was driving opposite from Unit 2 in the southbound lane. As Unit 1 came around the corner, Unit 1 drove into the northbound lane Unit 2 was occupying. Unit 2 was unable to avoid the collision and subsequently collided with Unit 1' trailer. Unit 2 suffered moderate damage to the passenger side doors and front fender, and front bumper due to the collision. The driver of Unit 1 said he was the sole occupant of vehicle while traveling southbound in about the 200 block of Bronson Way NE. The driver of Unit 1 stated that he stayed in his lane as he drove around the corner, near south entrance to Kaiser Permanente. He intended to make a right turn at the intersection, but as he approached the intersection, he observed Unit 2 go northbound on Bronson Way NE. As he straightened out, Unit 1 and Unit 2 collided in the northbound causing no damage to the trailer. The driver of unit 1 believes that Unit 2 purposely struck the trailer. When I arrived on scene, I observed the semi and its trailer halfway in the northbound lane. My observations coincide more with unit 2's story. 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. PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EF34658 r`I POLICE TRAFFIC 1 27 COLLISION REPORT CASE#1 24-11268 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT# 1 USDOT 0059556 ICC# VEHICLE TYPE 1 4 1 CARGO BODY 1 4 ;TYPE 2 ❑ 1 28 CARRIER NAME T P TRUCKING ....... 3 CARRIER ADDRESS 5630 TABLE ROCK RD CITY CENTRAL POINT ST OR ZIP 97502 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 4 AXLES 05 GwvR 51000 + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnnRFrtP. CITY ST ZIP 6 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No INTERLOCK YESE]NO� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREET"[—] ❑ 16 NFln+AnnRFs.� CITY'. ST SIP CDL IGNITION REQUIRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYSYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 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 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv 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. C.CATALAN 11-06-24 12:11 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 � OR ID# 12007 O#I',WA0171300 APJOHNSON 11/12/202 PAGE F OF 3000-345-013(R 11118) REPORT NO. EF34658 CASE# ' 24-11268 DATE AND TIME 10/30/24 10:31 OF COLLISION i, 1� a i a �5! PAGE 5 OF 5