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HomeMy WebLinkAbout24-11356 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 24-11356 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 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.. 11 — 01 — 2024 1400 17 ❑.❑ S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SW GRADY WAY BLOCK NO. e✓ 101 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 1 29 MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30 6� LAST NAME CHRISTIANSEN FIRSTNAME NICHOLAS MIDDLE J 1 1 2 31 INITIAL STREET ❑, 4317 S 300TH ST CITY AUBURN ST WA Zjp, 980012934 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� CO2184N sTAr� WAurN# 2NKHHM6X59M253658 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 7 3 33 12 3 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34 13 2009 KWDT BOX TR DAMAGE YES NO YES[:] NO✓ REGISTERED OWNER INFO OPTIMAS OE SOLUTIONS LLC 2141964TH AVE S KENT WA 98032 D:2534863367 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE INSURANCE CO FEDERAL INSURANCE COMP.7361.53.43 3 4 IN EFFECT &POLICY# 9TOP VEHICLe 5 36 LEGALLY YES❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE �UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5099617973 16 a LAST NAME MC MILLAN FIRST NAME PAT MIDDLE I L INITIAL 17❑ STREET ❑', 1124 S 44TH AVE CITY YAKIMA ST WA ZIP 989083911 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 M D.O.B. 07 23 _ 1959 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 BQT2498 TAre WA VIN1i 5TDDKRFH1ES055087 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2014 MAKE TOYT MODEL HIGHLAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO SHERRY MC MILLAN 1124 S 44TH AVE YAKIMA WA 98908 VEHICLE NO.2 SHADE DAGED AREA 4 LIABILITY INSURANCE INSU&PORGY#E CO LIBERTY MUTUAL AOS26849601770 3 8 1GQI IN EFFECTvE"'LE ❑ ,J� CITATION# CHARGE LEGALLY YES N`L J 25 s � e 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. EF37921 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11356 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MCMILLAN SHERRY (LAST FIRST, ADDRESS&PHONE# D O.B. 1124 S 44TH AVE YAKIMA WA 989083911 SEX F MMDDYyry 11 - 10 - 1961 PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ 2 POS, 3 2 4 1 USE 2 CLASS 11 NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D O B MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIRST 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. C.CATALAN 11-05-24 04:09 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 1112112024 7:29:10 AM BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 2:02 PSI TIME POLICE ARRIVED',Y:03 PM PART I PAGE IT]OF 5� TIME REPORT NO. EF37921 CASE# 24-11356 OF COLLISION11/01/24 14:00 NARRATIVE On November 1, 2024, at approximately 1400 hours, I was dispatched to an unknown-if-injury vehicle collision at 101 SW Grady Way, within the City Limits of Renton, County of King, State of Washington. Upon my arrival, the passenger of unit 2 stated that their arm hurt and needed to be medically evaluated. Later, Renton Fire arrived and determined that the injuries were minor. 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 he was traveling eastbound in about the 200 block of SW Grady Way and approaching the intersection of Rainier Ave S in lane 2 of 3. The driver of Unit 1 stated that he intended to continue straight through the intersection. As he proceeded, he heard a loud crunch noise. Unit 1 and Unit 2 collided in lane 1 of 3 causing minor damage to the driver's step rail of Unit 1. The driver of Unit 2 said he was accompanied by his front right passenger. He was also traveling eastbound in about the 200 block of SW Grady Way and approaching the intersection of Rainier Ave S in lane 1 of 3. The driver of Unit 2 stated he was intending to continue straight when Unit 1 began to merge left from lane 2 of 3 and into lane 1 of 3 which Unit 2 was occupying. The driver of Unit 2 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, bumper, and mirror. Based on the above statements, I determined that the Driver of Unit 1 is the proximate cause for the cause of collision as the driver 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. 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. EF37921 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-11356 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT# 1 USDOT ICC# VEHICLE TYPE 4 CARGO BODY 12 TYPE 2 ❑ H28 CARRIER 1 NAME OPTIMAS OE SOLUTIONS ....... 3 CARRIER ADDRESS 21419 64TH AVE S CITY KENT ST WA ZIP'', 98032 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 3 AXLES 02 GI14000 + 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 � CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES❑N0� 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 LIABILITY 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 REdUiR rD IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 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 11-05-24 04:09 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED 126 � RD# 12007 O#I'WA0171300 121 PAGE OF 3000-345-013(R 11118) REPORT NO. EF37921 CASE# ' 24-11356 DATE AND TIME 11/01/24 14:00 OF COLLISION Y Y 1 i k i S 3 n,Y z �3 is i s e PAGE 5 OF 5