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HomeMy WebLinkAbout24-6167 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EE97366
COLLISION REPRT 1591971
CASE# 24-6167 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOL`CO A`GENC'Y. 4200 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 03 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 06 - 12 - 2024 0845 17 =.= S 8 W e IN OF M ?070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE 4TH ST BLOCK NO. e 5301 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 170 00 FEET e✓ S 8 W e JERICHO AVE NE
OF 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES ✓NO O 1 30
6 LAST NAME LOPEZ LOPEZ FIRST NAME BRYAN MIDDLE N 1 1 2 31
INITIAL
STREET E:1 312 MT BAKER PL NE CITY RENTON ST WA ZIP 980594890 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs No INTERLOCKYEs NO YES Nc
8 DCIENS # STATE WA SEX M MMDCSYY' 10
❑ - 16 - 2003 1 2 32
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS ? NAruRE of INJURIES 2
10 LICENSE ti� B58035Z STATE WA VN# 5TFUM5F?3EX050389 3
11[-j- TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TRLR 5 7 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v 7 3 GOVT VEHICLE 34
13 2 2014 TOYT TUNDR DAMAGE YES ONO MEYERS YEs_ No
REGISTERED OWNER INFO BRYAN LOPEZ LOPEZ 312 MT BAKER PL NE RENTON WA 980594890 D:4252130527 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2
14 �
IN EFFECT &POLICY# NATIONAL GENERAL 29742 9TOP
VEHICLE CHARGE t 5 36
Lemur YES❑NO❑ CITATION# 7 o BOTTOM
15❑ sTINowH s 7 e
III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE r1wNFR YES 1/ NO D:3603206807
16�
LAST NAME THOMPSON FIRST NAME KA/LYN MIDDLE' M
INITIAL
17 F1 STREET ❑' ?8409 SE 263RD ST CITY COVINGTON ST, WA ZIP 980428437 37
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPORTED 38
INTERLOCKYES Na jNTERLOCK YES DNo YEs NU'
19 DRIVER'S STATE WA SEX I F I D.O.B. 12 _ 04 1995 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS CHEST INJURY
21 LICENSLATE E CFG0855 rarE WA vIN# JF2GTAEC6PH219203 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q23 MAKE SUBA MODEL CROSST STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES
�/ No GENE MEYERS ves No�/
REGISTERED OWNER INFO KAILYN THOMPSON 1.09 SE 263RD ST COVINGTON WA 980428437 D:3603206807 VEHICLE NO.2
SHADE dN DAMAGED AREA
4� 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 958273557
IN EFFECT &POLICY# 9TOP
LEE— ❑ ,.I—I CITATION# CHARGE tO BOTTOM
VEHICLE YES N`[
25 76
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.CATALAN 12007 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EE97366
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6167
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} HARRINGTON THOMASA
(LAST,FIRST
ADDRESS&PHONE# D(�
24977 SE 155TH PL ISSAQUAH WA 980278254 SEX' M MMDDYYYv 07 - 11 - 1954
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
Ej 3 POS. 1 2 4 1 USE 2 CLASS '1
'NAME
LAsr F RST,MIDDLE INITIAL) HENDRICKS KILLIAN
ADDRESS&PHONE#
S ' U D.O
EX .B.MDD -F L----------�
MYYYY
NATU
PASSENGER �WITNESS UNIT# 3 POS.SEAT 9 AIRBAG 2 RESTR. 4 EJECT 1 USE HELMET 2 INJURY RE OF INJURIES
CLASS 1 ----�
NAME MIDDLE INITIAL) MOLINA-BATRAS ISAI
',(LAST,FIRST,
ADDRESS&PHONE# D.O.
COVINGTON M _
SEX B.MMDD -F L----------�
YYYY
PASSENGER Z WITNESS UNIT# J
3 SEAT 9 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INURY 1 NATURE OF INJURIES
Q POS. USE
CASS
NARRATIVE
On June 13, 2024, at 0845 hours dispatch requested that I respond to a collision that occurred at
Jericho and NE 4th St, in Renton.
Upon my arrival I spoke with the driver of unit 3 and they explained that unit 1 was attempting to make
a left turn from the Chevron to go westbound on NE 4th St. As unit 1 proceeded across the roadway,
he was struck by unit 2, which then caused him to roll back. Unit 1 rolled across westbound lanes
which also prevented unit 3 from coming to a complete stop. Unit 3 struck unit 1's left side truck bed.
I then spoke with the driver of unit 1 and he explained a similar story. He stated he was making a left
turn to go westbound on NE 4th St. Two vehicles in the number 1 lane going eastbound, stopped,
and allowed him to cross. As he proceeded through, he failed to see unit 2 driving eastbound in the
number 2 lane. Unit 2 struck unit 1 driver side doors. His vehicle spun around and was struck by unit
3.
Unit 2 explained she was going eastbound on NE 4th St when unit 1 made a left turn the gas station.
She was unable to stop her vehicle in time, hitting unit 1's passenger side doors.
Unit 3 was unable to move under its own moving power, so a tow was arranged by (private) by school
district employees.
Unit 3 is the only vehicle that did not have its airbags deploy.
Based on the information i gathered that the driver of unit 1 failed to yield the right of way when
entering the roadway, causing the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 06-13-24 01:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 7/19/2024 1:57:46 PM
BADGE OR ID# 12007 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 8:46 AM TIME POLICE ARRIVED 8:55 AM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 57
POLIICFETRAFFICN CORRECTION REPORT NO. EE97366
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6167
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME POTLARRJU MEDHA
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE# D(?B
SEX U MMDDYYYY [------------�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
Q Q 3 Sp EAT
9 2 12 1 USE 2 +CLASS ;1
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD —F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS —_-- ----�
NARRATIVE
On June 13, 2024, at 0845 hours dispatch requested that I respond to a collision that occurred at
Jericho and NE 4th St, in Renton.
Upon my arrival I spoke with the driver of unit 3 and they explained that unit 1 was attempting to make
a left turn from the Chevron to go westbound on NE 4th St. As unit 1 proceeded across the roadway,
he was struck by unit 2, which then caused him to roll back. Unit 1 rolled across westbound lanes
which also prevented unit 3 from coming to a complete stop. Unit 3 struck unit 1's left side truck bed.
I then spoke with the driver of unit 1 and he explained a similar story. He stated he was making a left
turn to go westbound on NE 4th St. Two vehicles in the number 1 lane going eastbound, stopped,
and allowed him to cross. As he proceeded through, he failed to see unit 2 driving eastbound in the
number 2 lane. Unit 2 struck unit 1 driver side doors. His vehicle spun around and was struck by unit
3.
Unit 2 explained she was going eastbound on NE 4th St when unit 1 made a left turn the gas station.
She was unable to stop her vehicle in time, hitting unit 1's passenger side doors.
Unit 3 was unable to move under its own moving power, so a tow was arranged by (private) by school
district employees.
Unit 3 is the only vehicle that did not have its airbags deploy.
Based on the information i gathered that the driver of unit 1 failed to yield the right of way when
entering the roadway, causing the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 06-13-24 01:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 7/19/2024 1:57:46 PM
BADGE OR ID# 12007 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:46 AM TIME POLICE ARRIVED 8:55 AM
PART B 3aaa-345-,aa(R11Y1s) PAGE 37OF 57
SUPPLEMENTAL REPORT NO. EE97366
POLICE TRAFFIC
1 1 8 27
COLLISION REPORT CASE#+ 24-6167
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓
UNIT# 3 USDOT ICC# VEHICLE TYPE q TYPE CARGO BODY 1
CARRIER
2 ❑ 1 28 NAME ISSAQUAH SCHOOL DISTRICT
3 CARRIER L
ADDRESS 565 NW HOLLY ST
CITY ISSAQUAH ST WA ZIP 1 98027
4 ❑ NAME # PLACARD
NAME IF NO NUMBER
SOURCE 3 AXLES 02 GwvR 9000 +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
UNIT# 3 �✓ PEDESTRIAN �' ves✓ No D:4254455805
5 VEHICLE CYCLE OWNER
0 1 29
LAST NAME ONEAL FIRST NAME KIMBERLY MIDDLE; M
INITIAL
STREET 30
NEW ADDRFS, 17845 SE 266TH PL CITY COVINGTON ST WA ZIP 980424928
6 CDL -$ GNITION REQUIRED PRESENT MEDICAL TANSPORTED 1 1 2 31
I 'IGNITION
INTERLOCK YES. NO :INTERLOCK YEs No YES N .
DRIVERS STATE WA SEX P D'O'B 07 - 13 - 1971 G
LICENSE I MMDDY
7
ON DUTY STATUS: AIRBAG 2 RESTR. ¢ EJEG7 1 HELMET 2 INJURY 1 NAruREofINJURIES
USE CLASS
8 ❑ 1 32
LICENSE C2669C TAT WA VIN# 1GB6GUBGXH1203320
PLATE#
9 TRAILER TRAILER 2
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
.VIN.#. .VIN.#.
11 3 5 VEH.YEAR2017 MAKE CHEV MODELEXPRESS STYLE BU VEHICLE TOWE�/ E T ABLIYL TOW GOVT vEHlcl E ROM To
D YES NO ✓
REGISTERED OWNER INFOISSAQUAH SCHOOL DISTRICT565 NW HOLLYST ISSAQUAH WA 98027 AMAGE YES NO SHADE IN DAMAGED AREA 3 7 33
12 3 4
INSURANCE CO FROM TO
LIABILITY INSURANCE WASHINGTON SCHOOLS RISK MANAGEMENT SELF INSURED
❑ IN EFFECT 0 &POLICY# 9 TOV _ m 34
2 1n
13 vewc�e YES N0[jj CITATION# CHARGE xoTrom
ecauv
s-rnNoiNc � L 6
MOTOR PDAL_ ' 1:1P OPE El DAMAGE THRESHOLD MET PHONE ❑ 35
14 ❑ UNIT# VEHICLE CYECLE PEDESTRIAN OWNERRTY YES NO
15 LAST NAME FIRST NAME INITIAL E
❑ 36
16 ❑ STREET CITY ST ZIP
NFW AODRESa
GDL IGNI719N REZIUIRED 1ONITION PRESENT MEDICALTANSPORTED
INTERLOCK YES[]No INTERLOCK YES N(5 YES NO: ❑
17 37
LLIICENSE# SEX MDDD 8 Y' -= C----�
18 ❑ HELMET ❑
INJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ LICENSE TAT viN ❑ 39
PLATE# #
20 ❑ TRAILER TRAILER ❑ 40
PLATE#, STATE PLATE# - STATE
21 ❑ TRLR TRLR 41
VIN#�. VIN#;
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT I &POLICY# tK-99
5 44
vewc�e ❑ ❑ CITATION# CHARGE 24 IEGALLY VES NOSTIWDING3 3 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 06-13-24 01:49 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 BADGE 1 OR DD# 12007 O#RI WA0171300 APJOHNSON 7/119/2024
PAGE OF�
3000-345-013(R 11/18)
REPORT NO. EE97366 CASE# 24-6167 DATE AND TIME 06/12/24 08:45
OF COLLISION
_.
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7
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PAGE 5 OF 5