HomeMy WebLinkAbout24-12028 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
SASE 24-12028 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 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'. 11 - 1-— 2024 1650 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
EASTVALLEYRD BLOCK ST e✓
MILEPOST 4224
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2533984539 0 11
30
6� LAST NAME LAITMAN FIRSTNAME ROBERT MIDDLE F 1 2 31
INITIAL
STREET ❑ 2612 204TH AVE SE CITY SAMMAMISH ST WA ZIP 980759629 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ DRIVERS
# STATE WA SEX'M I ELMMDOVY' 08 — 08 — 2001 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS
2 CLASS 1 NATURE OF INJURIES 2❑
3
10 9❑ PI ATE 14 BNY4331 sTAr WA u N#' 1J4GA59158L538654
5 TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2008 JEEP WRANG DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO MICHELLE TEETER 10605 SE 240TH ST#626 KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 3 4
14 LIABILITY INSURANCE z PROGRESSIVE 7595354
IN EFFECT &POLICY# � 9TOP
15❑ vEHla.e
LECALLv res❑NO DI CITATION# 10 BOTTOM
CHARGE 36 STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES, NO D:4257531378
16 a
LAST NAME TEETER FIRST NAME CALVIN MIDDLE JA
INITIAL
17❑ STREET ❑', 22242 105TH AVE SE CITY KENT ST WA ZIP 980312545 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. O6 _ 27 1973 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 CKA8786 TAre WA VIN# 5TDBK3EH8DS264900
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2013 MAKE TOYT MODEL HIGHLAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO GRACE WHARTON 17329 SE 135TH ST RENTON WA 98059 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU POLICY#E CO SAFECO H2496762IN 0( 9TOP 5
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' 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. EF43963
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12028
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.
C.CATALAN 11-26-24 10:12 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/9/2024 12:47:31 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED; 4:54 PM TIME POLICE ARRIVED',5:02 PM
PART I PAGE IT]OF 4�
REPORT NO. EF43963 CASE# 24-12028 OF COLLISION
11/20/24 16:50
OF CbLLI510N
NARRATIVE
On November 26, 2024 at approximately 1650 hours, I was dispatched to an unknown-if-injury
vehicle collision at 4224 East Valley Rd, 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 2 said he accompanied by his front passenger and was traveling northbound in
about the 4200 block of East Valley Rd approaching the entrance of The Spot Sports Bar and Grill in
lane 1 of 2. The driver of Unit 2 stated he was intending to continue straight when Unit 1 changed
lanes from lane 2 of 2 and into lane 1 of 2 which Unit 2 was occupying. The driver of Unit 2 was
unable to avoid the collision and Unit 1 subsequently collided with Unit 2. Unit 2 suffered significant
damage to the front bumper due to the collision.
The driver of Unit 1 also said he was traveling northbound in about the 4200 block of East Valley Rd
and approaching the entrance of The Spot Sports Bar and Grill in lane 2 of 2. The driver of Unit 1
stated that he needed to get into the right lane (lane 1 of 2). The driver of Unit 1 stated he tried
making a right turn into the parking lot. The driver of Unit 1 stated that while making the lane change,
Unit 1 and Unit 2 collided in lane 1 of 2. Unit 1 struck unit 2 with their rear hitch cargo rack.
Based on the above statements, 1 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. The driver made a lane
change into Unit 2's lane of travel which had the right of way and was underway. The driver did not
ensure that traffic in lane 1 of 2 was clear of hazard before making the unsafe lane change.
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.
PAGE 3 OF 4
REPORT NO. EF43963 CASE# ' 24-12028 DATE AND TIME 11/20/24 16:50
OF COLLISION
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