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HomeMy WebLinkAbout25-80855 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG6176OLCERA COLLISION REPORT 1591971 INTERSTATE CITY STREET El CASE# 25-80855 2 STATE ROUTE OTHER LOL`CODIOENC'Y 4250 3 C©DING COUNTY RD PRIVATE WAY 2❑ TRIBAL UNITS#OF 04 SO""TRUCK MISC OBJECT OR DEBRIS ON ROAD 1 1 8 28 :RESERVATION : 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E eDL�ISION' 12 - 19 - 2025 0816 17 =.�� S WE IN OF 1070 3 4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLORENTON-MAPLE VALLEY MILE POST e Y900 .� 4a� MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 6 50 1.1 00 FEET e✓ S 8 W e SE STH ST 0 1 29 MOTOR PEDAL- DAM AG TSHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO ✓ 0 1 30 6 LAST NAME UNKNOWN FIRST NAME MIDDLE t 1 2 31 INITIAL STREET NEW ADDRESS CITY $EATAC ST: ZIP: 2 7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES No INTERLOCKYEs NO YES[:]NO 8❑ LCEENSE# SRVERSTTATE SEX U MMDDYY' —=— 1 2 32 9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 N USE ET 9 CLASSY 0 NAruRE of IN�uRIEs 2 LICENSE, 3 10� PI ATE#' STATE V(N TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR TRLR 4 8 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED fn TO BLIN TOWED By GOVT VEHICLE 8 4 34 13 DAMAGE YES NO ✓ YES NO✓ REGISTERED OWNER INFO OMA CONSTRUCTION 22412 SE 231ST ST MAPLE VALLEY WA 98038 D:2062621721 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 2 LIABILITY INSURANCE INSURANCE CO 2 3 4 14 WESTERN NATIONAL CPP1 211114 5 0 3 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE t S ❑ 36 ecnLLY YES❑NO❑ CITATION# 7 0 80TTOM 15❑ T Nowc s 7 e MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES NO �/ D:2069006737 16� LAST NAME SINGH FIRST NAME SIMRANJEET MIDDLE INITIAL 17 F1 STREET ❑ ❑ 3512 S 180TH ST APT F7 CITY SEATAC ST, WA ZIP 98188 g 37 NEW ADDRESS 1$ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38 CDL INTERLOCK YEs NO✓ INTERLOCK YES No✓ YES No✓ 19 DRIVERS STATE WA SEX M D.o.e. 09 17 1999 � 39 LICENSE# MMDDYY — HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSE I PATE# CUL8927 rare WA vIN# W1KQF4GB3PRO77006 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2023 MAKE NIERZ MODEL C CLASS STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ NO✓ REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 862748005 IN EFFECT &POLICY# 9TOP veHiaE ❑ ,J—I CITATION# CHARGE t080TTOM L'EGn�LY YES No 25 a e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 R.ONISHI 5738 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG61756 COLLISION REPORT III III III III III 111 1591972 CASE# 25-80855 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) SCHELLER DONNA ADDRESS&PHONE# 2003 136TH AVE E SUMNER WA 98390 2067309213 SEXi F MI MDDDYBYYY PASSENGEI—=— RF�WITNESSZ UNIT# : SEAT I AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS ----� :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 Unit 1 was large truck and attached dump trailer traveling in number 1 lane of northbound (compass SE to NW) Renton-Maple Valley Rd. Units 2, 3, and 4 all southbound (compass NW to SE) Renton- Maple Valley Rd. Johansen Construction was performing emergency construction on washed-out underpinnings to southbound Renton-Maple Valley Rd, and had large barrel-type traffic cones dividing northbound and southbound lanes. Dash camera video from unit 2 showed that trailer of unit 1 struck a traffic cone, propelling it into unit 2. Witness Scheller is a supervisor for Johansen, and saw the trailer wheels then strike three more cones, two of which hit unit 3 and unit 4. Unit 1 did not stop. Units 2, 3, and 4 all suffered minor damage from impact of cones. Dash video from unit 2 showed that the truck had an "OMA Construction" logo on the driver's door. OMA Construction office manager Heather Tyson told me that due to the number of trucks they have on the road, she did not know which of their trucks was involved; Tyson did provide me with insurance information for their fleet. Unit 1 did not stop after the collision; due to the size of the tractor-trailer rig, it is unknown whether the driver would have been aware that he hit the cones. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 12-19-25 03:58 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE D.SKELTON 9139 12/23/2025 3:35:47 AM BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 8:22 AM TIME POLICE ARRIVED i 8:30 AM PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF 4 SUPPLEMENTAL REPORT NO. EG61 756 POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE#1 25-80855 t113197 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY 3 TYPE 2 ❑ 1 1 $ 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP: 4 ❑ NAME # PLACARD —R NAME IF NO NUMBER SOURCE AXLES + 4a ADDITIONAL UNITS 'J MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT 3 VEHICLE CYCLE ❑ PEDESTRIAN :.. OWNER ',� YES NO D:2063490848 0 1 29 LAST NAME HUANG FIRST NAME FU : MIDDLE: J INITIAL 0 1 STREET 30 NEW Ar}nRFG❑; 11003 14TH AVE S CITY SEATTLE I ST WA ZiP gg168 6 ❑ 1 1 2 31 CDL IGNITION REZ7UIRE6 IGNITION PRESENT MECiICAL TANSPORTED'. INTERLOCK YES 0 NO�/ FINTERLOCK YES NO L DRIVER'S STATE WA SEX M D'O'B 02 LICENSE MMDDVYv - 24 - 1972 7 ❑ ON DUTY STATUS AIRBAG 2 RESTR. 4 EJECT 9 HELMET INJURY 1 NAruREofINJURIEs USE ;CLASS 8 ❑ 1 1 2 32 LICENSE BRJ3174 TAT WA VIN 5TDDZ3DC3LS236642 PLATE# 9 � TRAILER TRAILER L PLATE# STATE PLATE# STATE 0 10 TRLR TRLR VIN.#. VIN#. 11 3 5 VEH.YEAR2020 I MAKE TOYT MODELSIENNA STYLE VN VEHICLE TOWE E T ABLIN TOWED BY GOVT vEHICI E FROM To DAMAGE YES NO ✓ YES NO REGISTERED OWNER INFOOWN SHADE IN DAMAGED ED BYDRIVER $ t} 33 AREA 12 3 5 z 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO COUNTRY FINANCIAL A46A4261294 � IN EFFECT &POLICY# _J7t1P_ S $ 4 34 13 ❑ Ve..... YES❑ NO❑ CITATION# CHARGE 10 80TTOM sTANoINc DAMAGE THRESHOLD MET PHONE 35 14 UNIT# 4 MOTOR PEDAL- ❑ PEDESTRIAN ❑ PROPERTY YES NO uEHrCLE CYCLE OWNER ,/ D:2064993252 15 PINZON JOEL MIDDLE' 36 LAST NAME FIRST NAME INITIAL 16 STREET ❑' 800 SW TRENTON ST APT 101 CITY; SEATTLE ST WA ZIP 98106 NEW ADDRESS CDL IGNITION REfRED IGNITI©N PRESENT MEDICALTANSPt7RTED 17 F] INTERLOCK YES NO INTERLOCK YES Nt7 '.YES NO. DRIVER'S STATE WA SEX M D.O.B 37 LICENSE# MMDO yY 02 - 01 - 1988 18 ❑ ❑ C :2 !1 HELMET INJURY:.1 NATURE OF INJURIES 38 ON DUTY❑ STATU.� AIRBAG. RESTR. 4 EJECT USE ..CLASS.; 19 ❑ LICENSE' 3973G WA ❑ PLATE# D1 TAT ofN# 1 FMZU67E01 UA22330 39 20 TRAILER I I TRAILER 40 PLATE#,; STATE PLATE# - STATE ❑ 21 ❑ TRLR TRLR 41 VIN# VIN#: 42 22 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED DUET ABLIN TOWED BY GOVT.VEHICLE 2001 FORD EXPLOR PK DAMAGE YES No YES NO 23 REGISTERED OWNER INFO.OWNED BYDRIVER SHADE IN DAMAC ED AREA 43 �Cql�oip LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 987363064 1S 44 &POLICY#VEICE ❑ ❑ CITATION# CHARGE 6 24 I..EGALLY YES NO STF"_ 3 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 12-19-25 03:58 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 BADGE 5738 O#RI WA0171300 APSKELTON 12123/202 PAGE[3 OF 7 3000-345-013(R 11/18) REPORT NO. EG61756 CASE# 25-80855 DATE AND TIME 12/19/2508:16 OF COLLISION t �t, ( t4 u e tr' tt� t t f1t z r r tz� 4; a. t S � � i PAGE 4 OF 4