HomeMy WebLinkAbout25-2393 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-2393 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
dowsloN 03 - 1-- 2025 1248 17 ❑.= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 100
4a 1❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET e S MILES N B W e S 2ND ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066129584 0 11
30
6❑ LAST NAME BRANCH FIRSTNAME DARRICK MIDDLE A 1 2 31
INITIAL
STREET 01 12400 28TH AVE S APT G-3 CITY SEATTLE ST WA Zjp, 981682409 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 07 1— 17 — 1973 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ Pi ATE 14 BRH6243 STATE WA - 1J8FF57W27D286090
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IRM ro
TRLR. TRLR 7 1 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 2007 JEEP COMPA VT DAMAGE YES NO
YES[:] No✓
REGISTERED OWNER INFO DARRICK BRANCH 1240028TH AVE S APT G-3 SEATTLE WA 981682409 D:2066129584 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 LIABILITY INSURANCE❑ NATIONAL GENERAL 202242243201
IN EFFECT &POLICV# 9TOP
VewcLE CHARGE 1060TTOM 5 36
LEGALLY YES No CITATION# 5A0005662,5A0005662, OP MOT VEH W/OUT INSURANCE,FL
15❑ STANDING 8 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069631282
16 a
LAST NAME BERG FIRST NAME MICHELLE MIDDLE I L
INITIAL
17 STREET❑ NEW ADOREss❑' 6112 130TH PL SE CITY SNOHOMISH ST WA ZIP 982964253 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NoF,/
19 DRIVER'S STATE WA ]SEX IF D.Q.B. 05 _ 17 1967 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# 9NIR113 TATE CA VIN# 1GKENKKS2RJ187643 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
%
RLR
'I
VEH YEAR 2024 MAKE GMC MODEL ARCADIA STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO EAN HOLDINGS LLC 14002 E 21ST ST,SUITE 1500 TULSA OK 74134 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU8 PORGY#E CO ALLMERICA FINICIAL BENEFIT AW2-H262807 1 9TOP 5
IN EFFECT
VEHICLE YES[:] N
,.I
LEGALLY _] CITATION# CHARGE i o BOTTOM
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.CHANG 10065 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF78595
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2393
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.
E.CHANG 03-23-25 01:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 313112025 2:43:47 PM
BADGE OR ID# 10065 OR]#' I WA0171300 TIME POLICE DISPATCHED 4:08 Pry TIME POLICE ARRIVED',1:14 PM
PART I PAGE IT]OF 4�
REPORT NO. EF78595 CASE# 25-2393 OF COLLISION
03/17/25 12:48
OF CbLLI510N
NARRATIVE
RTF
On 03-17-2025 at about 1306 hours, I was sent to a collision which occurred in the 100 block of
Rainier Ave S, in the City of Renton, King County, Washington.
Upon arrival I spoke with both parties and they have the same account.
Unit 1 was pulling out of the Auto Zone driveway at 175 Rainier Ave S. The was construction but a
path was available for unit 1 to exit onto Rainer Ave S. The driver of unit 1 made a northbound turn
and collided with unit 2 which was headed northbound in lane 2. Inspecting the area there were no
visual obstructions which would have prevented unit 1 from seeing unit 2.
Driver 2 did not have any traffic control devices prohibiting them from driving straight. There was no
expectation for unit 2 to yield to unit 1.
The driver of unit 1 did not yield right of way to unit 2 which was a contributing factor in the collision.
I asked the driver of unit 1 for his license registration and insurance. He was positively identified via a
WADL as Branch, Darrick A (07-17-1973). Concerning his insurance, he said I got, and he had to get
the policy online. I asked him to pull it up for me and he said he couldn't and he had to call to get it. I
asked him when did he call and he said he just called and his insurance was with National General.
Later I asked him for his insurance information, and he said it as with National General and the policy
number was 202242243201. He said he got the insurance with Vern Fonk and gave me their phone
number. I called the number and was transferred to National General. I was asked to enter the policy
number, so I called Branch over and he read out his policy number to me "202242243201" and the 5
digit zip code 98168 which was on the policy. I was informed that
the policy was canceled November 24th, 2024. Due to insured's request.
Branch did not have insurance upon request.
He also provided false evidence of financial responsibility by knowingly providing false evidence of
financial responsibility to a law enforcement officer, including an expired or canceled insurance
policy. Branch gave me his canceled insurance policy from National General and policy number
202242243201. He had canceled his insurance on November 24th 2024.
He also emerged unsafely from the driveway of AutoZone making a left turn merging into unit 2's lane
of travel and striking unit 2.
Upon further inspection Branch's vehicle with WA plate BHR6243 had expired tabs expiring on 10-21-
2024.
PAGE 3 OF 4
REPORT NO. EF78595 CASE# ' 25-2393 DATE AND TIME 03/17/25 12:48
OF COLLISION
t
ti
�w
l
� 4 I
ct
t
�y
r
PAGE 4 OF 4