HomeMy WebLinkAbout24-12465 ("7—
STATETc" 5 27cRaFFi O EF44832
,one COLLISION REP F 1591971
CASE# 24-12465 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coATL s ory 12 - 04 7- 2024 0807 17 a. S e W 8 OF 8 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
MAPLE VALLEY HWY
MILE POST
❑4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.= FEET e S e W 8 CEDAR RIVER PARK DR
0 1 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YEs ,/NO D:8056167055 0 8 30
g LAST NAME CANNELLA FIRST NAME DAVID r MIDDLE' M 1 2 31
INITIAL
STREET E:1' 15150 140TH WAY SE UNIT N101 CITY RENTON WA
NEW ADDRESS S7 ZIP 98058 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YEs No INTERLOCKYEs No YES Na
DRIVE STATE WA SEX'U MMDDYy; 07 - 15 - 1974 1 2 32
g❑
9 ON DUTY STATUS AIRBAG 2 IRE STR 4 EJECT 1 H U5 E7 CLASRS 1 NATURE OF INJURIES 2
PI ATNStt CFY1188 STATE
WA WIN# WVWDB7AJ1DW124163 3
10 1❑
11 4 0 PLATE# STATE PLATRAITE# STATE ROM To
rRL R TRLR 5 1 33
12 0 0 VIN#' uIN#
FROM TO
13 2 VEH.YEAR2013 MAKE VOLK MODEL GOLF STYLE VEHICLETOWEED2NODi�ABLIN tIHNKRS GOVT,VENOCL✓ g 9 34
❑ DAMAGE II1I._IIII tlAlVt(t ccJllu—'II
REGISTERED OWNER INFO DAVID CANNELLA 15150140TH WAY SE UNIT N10f RENTON WA 98058 D:8056f67055 VEHICLE NO. 1J�j ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NSURANCE CO SAME. 4
IN EFFECT &POLICY# STOP
VEHICLE CHARGE 5 ❑
rano <1 36
e�ALI Y YES❑NO❑ CITATION# 4A0765739 INATTENTIVE DRIVING o BOTroM
15❑ swc 7 6
I� MOTOR PEDAL- � � PROPERTY E]JDAM THR OLD MET PHONE
UNIT 02 lv I ❑ PEDESTRIAN I—I
VEHICLE CYCLE. OWNER YES� NO
16�
LAST NAME RAMOS MARTINEZ FIRST NAME MARIA MIDDLE D
INITIAL
17❑ STREET El 15110 197TH ST E CITY ORTING ST', WA ZIP 983608407 37
NEW ADDRESS I I I 1 ❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
1NTERLOCKYEs No INTERLOCK YEs N -11 YES NOR I
19❑ DRIVER'#
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N U MEET IINLJAURY 1 NATSS URE OF INJURIES ❑ 40
21❑ LICENSE gTN8987 TATE WA vtN# 1N4BL4CV9LC204190
❑ 41
PLATE#
TRAILER TRAILER ❑22 PLATE# STATE PLATE STATE 42
23 43
TRLR RLR
VIN#. '[N#,
VEH.YEAR 2020 MAKE /I//SS MODEL ALT/MA STYLE DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
YES O
24
REGISTERED OWNER INFO MARIA RAMOS MARTINEZ 15110 f97TH STE ORTING WA 98360 D:2068597149 VEHICLE NO.2
SHADE IN DAMAGAREA
LIABILITY INSURANCE INSURANCE CO E 3
IN EFFECT &POLICY# t 4TOP
Venice � C[:] CITATION# CHARGE tOBOTTOM
LEGALLY YES N
25 s
71FFLIIER�S NAME(PRINT) OFFICER PHONE BADGE OR ID# FA
ENCY
26
VERTON 2517 0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF44832
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12465
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. I USE CLASS
NARRATIVE
In 3 red/2 blk/1 look down
CC
Within the city limits of Renton/King/WA I responded to a 2 car crash at the intersection of Maple
valley Hwy at Cedar River Park Dr.
I contacted the driver of unit 2 who told me she was northbound stopped in lane 3 for the stop light for
about 1 minute before she was struck in the back by unit 1. She did not complain of injury, but
Renton Fire checked her as a precation/pregnant. She did not require a tow truck for damages.
I contacted the driver of unit 1 verbally ID'd as David M Cannella. A WACIC/DOL check via Dispatch
revealed he was clear and valid. He told me he was distracted inside his vehicle, looked down and
looked up and ran into the back of unit 2. He did not complain of injury and damages did require a
tow truck. (Bankers)
I cited unit 1 ref RMC 10-12-25 Driver Inattention 2 vehicle crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 12/04/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 12-05-24 06:53 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1211112024 2:41:49 PM
BADGE OR ID# ! 2517 ORI# WA0171300 TIME POLICE DISPATCHED 6:11 AM TIME POLICE ARRIVED i 8:15 AM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F3
REPORT NO. EF44832 CASE# 24-12465 DATE AND TIME 12/04/2408:07
OF COLLISION
�y
rls �
e 9
s
�Sr is
t t��
s m..
c
a I�
5 s
1
t
4r� m
{f
}�t
PAGE 3 OF 3