HomeMy WebLinkAbout26-2766 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG93916oc� RA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 26-2766 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCCODIOENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 03 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCLson' 04 - 09 - 2026 1424 17 =.= S 8 W e IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e 1400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 50 1.1 00 FEET e✓ S 8 W e S PUGET DR
0 6 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2065034019 0 8 30
6 LAST NAME HOERNER FIRST NAME CAROL MIDDLE D 1 1 31
INITIAL
STREET ❑ 11911 SE 168TH ST CITY; RENTON ST WA ZIP; 98058 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKvEs NOW INTERLt)CKYES Na�/ YES NO
8 DRIVER # STATE WA SEXI F MMDDYY' 11 - 30 - 1947 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET CLASSY ? NAruRE of INJURIES 2
10 LI ENSE' AVD8947 STATE WA VIN# 4T1BF1FK3EU810403 3
TRAILER STATE TRAILER STATE ROM TO 11 3 5 PLATE# PLATE#
TRLR zRLR. 1 5 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2014 MAKE TOy. MODEL CAMRY STYLE SD VEHICLE TOWED TO BLIN TOWED By GES VEHICLE 9 9 34
13 DAMAGE YES YES) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 NSURANCE CO 3 4
14 LIABILITY INSURANCE� TRAVELERS 617529877 203 1
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 36
Lemur YES[:]NO[:] CITATION# 7 0 80TTOM
15❑ sTnNowc s 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE PROPSnWNr YES NO �/ D:4257739737
16�
LAST NAME GARMA FIRST NAME KRISTOFFERSON MIDDLE S
INITIAL
17 F1 STREET ❑
❑ 16512 126TH AVE SE CITY RENTON ST, WA ZIP 98058 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES NO INTERLOCK YES NO vEs No
19 DRIVERS STATE WA SEX M I D.O.C. Fl2 17 1990 � 39
LICENSE# MMDDYY I I —
:
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY NATURE OF INJURIES 40 USE CLASS ? ❑
21 LICENSE D83425A TATe WA VIN# 3FTTW8E30NRA92599 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2022 MAKE FORD MODEL MAVERIC STYLE pl( VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO NO
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO FARMERS 983205780.0
IN EFFECT &POLICY# t STOP
YewCLe EEEILY YES ,.I
N`.L—J I CITATION# CHARGE to BOTTOM
25 s s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG93916
COLLISION REPORT III III III III III 111
1591972 CASE# 26-2766
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) NOUCH ROSA
ADDRESS&PHONE#
16512 126TH AVE SE RENTON WA 98058 SEXi F MMDDD B. 10 - 05 - 1991
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
�; 2 POS. : 3 2 4 1 USE CLASS 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) GARMA GABRIEL E
ADDRESS R PHONE#
16512 126TH AVE SE RENTON WA 98058 SEX' M D•o.B. 06 _ 01 _ 2025
MMDDYYYY
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# 2 POS. ' 6 AIRBAG 2 RESTR. 11 EJECT 1 USE CIA SS 1 ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX/ D.O.B. -
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
Unit 2 in turn lane from s/b Talbot Rd S to eastbound S Puget Dr, stopped for red light. Unit 1 s/b
following unit 2. Unit 3 following unit 1. Driver 1 Hoerner told me that as she approached unit 2, her
car suddenly accelerated without any pedal input, striking unit 1. Hoerner said that she tried to shift
into reverse as she approached unit 2, but after the impact her car abruptly accelerated backwards
into unit 3. Driver 2 Garma told me that he was stopped for red signal when unit 1 struck his truck
from behind. Driver 3 Nguyen told me that he saw unit 1 suddenly accelerate into the back of the
stopped unit 2, then reverse into Nguyen's vehicle.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 04-09-26 03:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 4/13/2026 3:45:43 AM
BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:26 Pry/ TIME POLICE ARRIVED i 2:31 PM
PAST B 3 Da-3mx-attar(t 1Mff) PAGE 2�OF 4
SUPPLEMENTAL REPORT No. EG9391 6
POLICE TRAFFIC
1 1 8 27
COLLISION REPORT CASE#i 26-2766
t113197
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 DAMAGE THRESHOLD MET PHONE
UNIT# 3 �✓ PEDESTRIA1:1N vps No D:2067303088
5 VEHICLE CYCLE OWNER
0 6 29
LAST NAME NGUYEN FIRST NAME HUY MIDDLE. H
INITIAL
STREET 30
NEW ADDRF 1503 S 28TH PL CITY RENTON I ST WA ZiP gg055
6 [2 1 1 2 31
CDL IGNITION REQUIRED 1{iNi7ION PRESENT MECiICALTANSPORTED'.
INTERLOCK YESO NO�/ INTERLOCK YES NOR YESD N,W
L
DRIVER'S STATE WA SEX M D'O'B 01
7
LICENSE MMDD' - 01 - 2003
ON DUTY STATUS AIRBAG 2 RESTR. 4 EJECT 9 HELMET INJURY 1 NAruREofINJURIEs
USE ;CLASS ;
8 ❑ 1 32
LICENSE CNK7733 TAT WA VIN 1C3CCCAB2FN725900
PLATE#
9 TRAILER TRAILER L
PLATE# STATE PLATE# STATE
0
10 ❑ TRLR TRLR
VIN.# VIN#.
11 3 5 VEIL YEAR201 Jr I MAKE CHRY MODFL200 STYLE SO VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI E FROM TO
DAMAGE YES NO ✓ YES NO
REGISTERED OWNER INFOOWNED BYDRIVER $ 33
SHADE IN DAMAGED AREA
12 � 3 4
FROM TO
LIABILITY INSURANCE INSURANCE COSTA 7E FARM 5699872-E07-47A <DQ
IN EFFECT &POLICY# 5 34
13 ve A" YES❑ NO❑ CITATION# CHARGE ..
ecauv .
sTnNoiNc
MOTOR PEDAL_ ' 1:1PROPERTY : DAMAGE THRESHOLD MET PHONE 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
36
15 LAST NAME FIRST NAME NIT AL
16 ❑ STREET CITY ST ZIP
NEW ADDRESS"
CDL IGNI71t7N REQUIRED IGNITION PRESENT MEDICAL TANSPORTED.
INTERLOCK YES NO INTERLOCK YES No IYES[-]NO' ❑
17 37
LIRIVERSICENSE# STATE SEX Moog
L _ C-----�
18 ❑ ❑
HELMET INJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ ❑ 39
LICENSE TAT viN#
PLATE#
20 TRAILER 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
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAC ED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT I &POLICY#
..
)
E 44
24 YES❑ NO CITATION# CHARGE OM
S _ 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.
R.ONISHI 04-09-26 03:34 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OR Ib 5738 O#RI WA0171300 APSKELTON 4/113/2026
PAGE OF
�
3000-345-013(R 11/18)
REPORT NO. EG93916 CASE# 26-2766 DATE AND TIME 04/09/26 14:24
OF COLLISION
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