HomeMy WebLinkAbout24-12846 POLICE TRAM 27iTFFiNc
COLLISION REP F 1591971
CASE# 24-12846 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 2 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75#OF02 STRUCK TOTAL OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
LOLL s ON 12 - 16 7- 2024 0727 17 a. S e W 8 OF IN 8 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NONINTERSECTION ❑✓
BLOCK NO.
MAPLE VALLEY HWY MILEPOST T
❑ MILEPOST
8 2200
4a .�
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S e W B
2 0 29
MOTOR PEDAL- DAM E THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES ,/No D:4153007705 0 1 30
6� LAST NAME KIMANI FIRST NAME RUTHU MIDDLE' W 1 2 31
INITIAL
STREET E:1' 31008 18TH AVE S#17 CITY FEDERAL WAY WA
NEW ADDRESS S7 ZIP 98003 z
7❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES No INTERLOCKYES No YES Na
DRIVE STATE WA SEX'F MMDDYY 11 - 12 - 1967 1 2 32
8❑ LICENSE
9 F] ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES 2
LIC NSE CAZ2693 srArE WA WIN# 4T1BF1FK9GU135126 3
10 9❑
RAILER TRAILER
11 4 0 PLATE# STATE PLATE# STATE FROM -
TRLR TRLR. 3 7 33
12 4 O VIN#' VIN#
FROM TO
13 4 VEH.YEAR 2015 MAKE TOYT MODEL CAMRY STYLE 4D VEHICLDAMAGETOWEEDJ:tl T02fBLIN TOWED BY GOVT.VEHIICLNOF✓ 3 7 34
❑ REGISTERED OWNER INFO OWNEDBYDRIVER IIIL—llll VEHICLE c�NJll OO..'II 1
SHADE 1N DAMAGED AREA ❑ 35
LIABILITY INSURANCE❑ INSURANCE CO 4
14 GEICO 6166-44.43-04
IN EFFECT &POLICY# STOP
VEHICLE CHARGE ❑ 36
EGALI V YES❑NO❑ CITATION# I 14 BOTTOM 5
15❑ GT—N. a e
yE' MOTOR PEDAL- 'pEDES7RIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE OWNER YES NO D:5419482674
16�
LAST NAME OHNSON FIRST NAME MALORY MIDDLE' W
INITIAL
17 STREET El 21808 148TH AVE SE CITY KENT ST', WA ZIP 98042 4
NEW ADDRESS 37
❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED E 38
INTERLOCK No INTERLOCK YES N ves NOR I
19❑ DRIVER'#
❑ ON DUTY[:]I I STATUS AIRBAG 2 RESTR 4 EJECT 1 H�SET 2 INJURY
1 NATURE OF INJURIES 40
❑21❑ PLATE D11050D TATE;WA VIN# 5TFBV54187X015924 41
1
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. 'IN#,
VEH.YEAR 2007 MAKE TDYT MODEL TUNDRA STYLE PK DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
YES O
24
REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2
SHADE IN DAMAGED AREA
LIABILITY INSURANCE ✓ INSURANCE CO PROGRESSIVE 966-08-0930 2 3 4
IN EFFECT &POLICY# t 4TOP 5
—1-1 ❑ U CITATION# CHARGE tOBOTTQM
EEcnEEv YES N J
25 e
7.FFIS NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
OBS 7 1953 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF47937
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12846
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
On 12-16-24 at about 0742 1 arrived in the 2200 block of Maple Valley Hwy (MVH) for a 2 vehicle
blocking collision. Both vehicles were stopped in westbound lane 1. 1 contacted both drivers in/or
near their vehicles. Driver 1 told me;
She was in lane 2 and had her signal on to change lanes.
She thought that since she had her signal on she was able to change lanes.
She was uninjured.
I explained to driver 1 that she must make sure that she can safely change lanes prior to merging.
Just having the signal on does not make it safe for her to merge. Unit 2 was legally upon the roadway
and in lane 1 when unit 1 started the move. Driver 1 appeared perplexed by the idea that she didn't
have the right to change lanes.
Driver 2 told me;
She was in lane 1 when unit 1 suddenly started to come over into her lane.
She attempted to stop but was unable to avoid the collision. She was uninjured.
Both vehicles were released to the drivers and were driveable.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 12-16-24 04:53 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1211912024 1:50:32 PM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED; 7:31 AM TIME POLICE ARRIVED i 7:42 AM
PART B 3000-345.160(R1Vt8) PAGE 0 OF F3
REPORT NO. EF47937 CASE# 24-12846 DATE AND TIME 12/16/2407:27
OF COLLISION
PAGE 3 OF 3