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Home My WebLink About25-1969 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF71826OLCERA COLLISION REPORT 1591971 INTERSTATE CITY STREET FIRE I CASE# 25-1969 2 RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eaCL s on' 03 - 03 - 2025 0941 17 =.[� S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE SUNSET BLVD BLOCK ST e 2813 .= 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET B S B W e 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2534992405 0 1 30 5 LAST NAME HARTMAN FIRST NAME MARK MIDDLE D 1 2 31 INITIAL STREET ❑ 11719 SE 210TH PL CITY; KENT ST I WA ZIP 980312140 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3 INTERLOCKYEs No INTERLOCKYES .- YES NO 8❑ DCIENSE# STATE WA SEXI M MMDDYY' 11 — 07 — 1996 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASSY 1 [NATURE of INJURIES 2 LICENSE, C52766Z STATE WA VIN# NMOLS7E78F1181323 3 10 Fq I as ATP tt TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR rRLR 7 1 3 33 12 3 5 VIN# vIN# FROM TO 13 2 VEH.YEAR2015 MAKE FORD MODEL TRANSI STYLE VEHICLE TOYED NO�iS46LIN T� {J RSTOWING GCS❑VT EHICLE No� 7 3 34 DAMAGE IIII._IIII REGISTERED OWNER INFO LLC INFINITY PROPERTY MANAGEMENT 14508 NE 20TH STSTE 2008ELLEVUE WA 98007 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 2 LIABILITY INSURANCE INSURANCE CO 4 14 OHIO SECURITY INSURANCE BAS 57048299 IN EFFECT &POLICY# 9TOP VEnicLE CHARGE t S 36 LEc LT YES[:]NO[:] CITATION# 70 80TTOM 15❑ STANDING e MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:4255426030 16� LAST NAME WENG FIRST NAME Yl MIDDLE M INITIAL 17 F1 STREET ❑❑ 16568 SE 48TH PL CITY BELLEVUE ST, yyq ZIP 37 980065872 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. ❑ 38 INTERLOGKYES No INTERLOCK YES No YEs NO 19 DRIVER'S STATE WA SEX I M D.O.B. 09 27 1978 � 39 LICENSE# MMDDYY — HELMET INJURY: NATURE OF INJURIES 4Q 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑ 21 LICEN� ANC6624 TATE WA VIN# rv1RS640352442517 41 PLATE 22❑ [TILER TRAILER PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2005 MAKE VDLV MODEL $60 STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24� DAMAGE YES NO� VES NO REGISTERED OWNER INFO SHOU-JOUPISTON16568SE48THPL BELLE WA 98006 VEHICI...E NO.2 SHADE IN DAd%GWREA 2 AAA LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 966946052 IN EFFECT &POLICY# 9TOP Ve—L ,J—I CITATION# CHARGE to BOTTOM LEGALLY YES❑ N`[ 25 a e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 C.CATALAN 12007 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF71826 COLLISION REPORT III III III III III 111 1591972 CASE# 25-1969 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES 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 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 03-03-25 03:09 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED APPROVED BY DATE M.LEVERTON 2517 3/7/2025 2:14:14 PM BADGE OR ID# 12007 ORI# WA0171300 TIME POLICE DISPATCHED 9:41 AM TIME POLICE ARRIVED i 9:55 AM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF REPORT NO. EF71826 CASE# 25-1969 OF DATE AND r�N + 03/03/25 09:41 O�COLLISION NARRATIVE On March 3, 2025, at approximately 0941 hours, I was dispatched to an unknown-if-injury vehicle collision at Jack in the Box, 2813 NE Sunset Blvd, within the City Limits of Renton, County of King, State of Washington. Witnesses reported that the driver of a white van appeared to have suffered a seizure while driving, causing the collision. Upon my arrival, I spoke with a witness, identified as Michael W. Vaughhan. He stated that unit 1 traveled across the oncoming traffic lanes at a slow rate of speed and then hit a stop sign, which disabled the vehicle. After unit 1 came to a stop, Michael observed that the driver had a seizure. Michael said the driver of unit 1 was flailing his arms inside the vehicle, his head was tilted back, and his eyes had completely rolled back. While on scene, I noticed that Mark had calmed down and appeared to be recovering. He was conscious but unresponsive when RRFA contacted him. The driver of Unit 2, identified as Yi Weng, said he was traveling eastbound in about the 2800 block of NE Sunset Blvd approaching the Jack in the Box in lane 2 of 2. Yi stated he was intending to continue straight when Unit 1 changed lanes from lane 1 of 2 and into lane 2 of 2 which Unit 2 was occupying. Yi was unable to avoid the collision and Unit 1 subsequently collided with Unit 2. Yi mentioned that Unit 1 bounced off his vehicle several times before colliding with unit 3. Unit 2 suffered moderate damage to the passenger side doors and rear right quarter panel. The driver of unit 3, identified as Xiao Kuang, said she was traveling eastbound in about the 2800 block of NE Sunset Blvd approaching the Jack in the Box in lane 2 of 2. As she approached the entrance of Jack in the box, unit 1 side swiped her vehicle causing minor damage to her rear right wheel well. Unit 1 then veered left, onto oncoming traffic, and drove into a stop sign. Unit 1 sustained moderate damage, but the vehicle appeared drivable. spoke with Mark briefly, but he stated he didn't remember much. I did not question him further. Mark was transported to VMC. Unit 1 was privately towed by the owner. Based on the above statements, 1 determined that the Driver of Unit 1 (Mark) is the proximate cause for the cause of collision as Mark 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. Mark made a lane change into Unit 2's and Unit 3's lane of travel which they had right of way. An exchange of information was provided to all involved parties. 1 will also submit a re-evaluation for Mark to DOL. No citation. Information only. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. C. Catalan 03/07/2025 Renton PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EF71826 POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 25-1969 013197 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY: TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACARD GWVR NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT 3 VEHICLE ( CYCLE ❑ PEDESTRIAN OWNER ❑'. YES NO D:2063216172 H 29 LAST NAME KUANG FIRST NAME XIAO MIDDLE. M INITIAL STREET 30 NFW ADnRES 4124 NE IOTH ST CITY RENTON ST WA ZIP 980594534 6 CDL GNITION REOUiRED PRESENT MEDICALTANSPORTED'. 1 1 2 31 I 1{iNi7ION :: INTERLOCK YES NO ':INTERLOCK YESLl NG YES N DRIVER'S STATE WA SEX F D.O.B 08 12 - 1973 2 LICENSE MMDDYYY 7 ON DUTY STATUS AIRBAG 2 RESTR. ¢ EJECT 1 HELMET 2 INJURY 1 NAruRE of INJURIES USE CLASS 8 ❑ 1 32 LICENSE AQC2776 TAT WA VIN 4T4BF1FK6CR182114 PLATE# 9 TRAILER TRAILER L PLATE# STATE PLATE# STATE 0 10 TRLR TRLR VIN.# VIN#. 11 3 5 VEIL YEAR2012 MAKE TOYT MODELCAMRY STYLE VEHICLE TOWE E T ABLIN TOWED BY GovT vEHICI E FROM To DAMAGE YES NO ✓ YES NO REGISTERED OWNER INFOXIAO KUANG 4124 NE LOTH ST RENTON W SHADE IN DAMAGED AREA A 98059 7 3 33 12 � FROM TO LIABILITY INSURANCE INSURANCE CO SAFECOINSURANCE H2457899 IN EFFECT &POLICY# J '`1T�I-___ S m 34 13 ❑ ve A" YES NO CITATION# CHARGE 10 C30i TOM e 'v MOTOR PEDAL_ ' PF20pERTY DAMAGE THRESHOLD MET PHONE 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 36 15 LAST NAME FIRST NAME INITIAL 16 ❑ STREET CITY ST ZIP NEW ADDRESS" CDL IGNITION REQUIRED IGNITION PRESENT ME 'CA INTERLOCK YES NO INTERLOCK YES NO 'YES NO' 17 37 RIVERSLLIICENSE# STATE SEX M ooYB 18 ❑ _ ❑ HELMET INJURY NATURE OF INJURIES 38 ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS. 19 ❑ ❑ 39 LICENSE TAT AN# PLATE# 20 TRAILER+ TRAILER 40 PLATE#.: STATE PLATE# STATE ❑ 21 ❑ TRLR TRLR 41 VIN# VIN#Y 42 22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUET ABLIN 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# w� ) E 44 24 vIece YES❑ NO CITATION# CHARGE OM STF_ G 8 3 G 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.CATALAN 03-03-25 03:09 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OR Ib# 12007 O#RI WA0171300 APPROVED BY 3n/2025 PAGE OF� 3000-345-013(R 11t18) REPORT NO. EF71826 CASE# 25-1969 DATE AND TIME 03/03/2509:41 OF COLLISION> ' i } � h lu }t tt t �s 4� PAGE 5 OF 5