HomeMy WebLinkAbout24-12040 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-12040 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 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'. 11 - 1-- 2024 2135 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S GRADY WAY BLOCK NO. e ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a RAINIER AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2069543357 0 4 30
6� LAST NAME LEHMAN FIRSTNAME JEFFREY MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 1817 SW ELMGROVE ST CITY SEATTLE ST WA ZIP' 98106 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� AZH5756 sTArI WAurN# 4T48F3EK1BR173056
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# IR.. To
TRLR. TRLR 1 5 33
12 6 0 VIN# VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 7 34
13 3 2011 TOYT CAMRY SD DAMAGE vEs 0NO f �LAWkkRS vEs❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 1702434DO447B 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2065102126
16 a
LAST NAME HOLBROOK FIRST NAME GARETT MIDDLE IR
INITIAL
17 STREET NEW ADOREs�' 13404 NEWCASTLE COMMONS DR APT509 CITY NEWCASTLE ST WA ZIP 98059 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[-] D IVEW # STATE WA SEX M MMor w 08 _ 08 _ 1976 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 WEB SET 2 NJAURSY 7 [-�A—TURE OF INJURIES POSSIBLE KNEE INJURY,REFUSED TREATMENT ❑ 40
LICENSE I ❑21❑ PLA E# CFG7131 TArE WA VIN# 41
SFNYF8H59N6026332 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED By Gov HI 44
VEH YEAR 2022 MAKE HOND MODEL pgSSPOR STYLE $V —VEHICLE
TOWED✓ NOO BLIN BANKERS YES NO�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO GEIC04476249752IN 9TOP 5
VE—LE ❑ ,J� CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N J
' e
=AS
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 SWAN 7 12965 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF38218
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12040
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
NICHOLAS SWAN 11-20-24 11:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 1112112024 9:04:03 PM
BADGE OR ID# 12965 OR]# WA0171300 TIME POLICE DISPATCHED; 9:35 PM TIME POLICE ARRIVED',9:35 PM
PART I PAGE IT]OF 4�
REPORT NO. EF38218 CASE# 24-12040 OF COLLISION
11/20/24 21:35
OF CbLLI510N
NARRATIVE
#24-12040
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 11/20/2024 at approximately 2135 hours I was dispatched to the intersection of Rainier Ave S and
S Grady Way in the city of Renton, King County, WA, for a two motor vehicle collision without injuries.
I arrived on scene and found Unit 1 a black 2011 Toyota Camry with WA LIC: AZH5756 and Unit 2 a
black 2022 Honda Passport with WA LIC: CFG7131.
Driver 1 of Unit 1 was traveling south in lane 1 on Rainier Ave S and entering on to Hwy 167. The
intersection was dark due to power being out and Unit 1 stated he did not see Unit 2 proceeding
through the intersection. Unit 1 had significant damage to the front of the vehicle and was unable to
drive away under it's own power. Other officers on scene helped push the vehicle out of the
intersection.
Driver 2 of Unit 2 was exiting Hwy 167 in the left hand turn lane and turning west bound on to SW
Grady Way. As he was turning he said he got hit abruptly by Unit 1 who he stated was traveling at a
high rate of speed. Unit 2 had extensive front end damage to the vehicle and was unable to drive
away under it's own power. Other officers on scene were able to push the vehicle to the side of the
road with their patrol cars.
I provided both drivers with an exchange of information.
Banker's Towing towed both vehicles away to the owners destination of choice.
The drivers of both vehicle were wearing their seatbelts and declined medical aid. No air bags were
deployed for either vehicle. Driver 2 stated he may have hurt his knee and possibly his back but did
not want fire to check him out.
I took pictures of both vehicles and uploaded them to Axon.
At the conclusion of my investigation, I determined that the proximate cause of the collision is due to
Unit 1 failing to stop at an intersection where the light was out. This intersection should have been
treated like a 4 way stop.
If Unit 1 would have used the intersection as a 4 way stop then this collision would not have occurred.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer N. Swan #12965 on 11/20/2024 at 2236 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. EF38218 CASE# ' 24-12040 DATE AND TIME 11/20/24 21:35
OF COLLISION
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PAGE 4 OF 4
