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Home My WebLink About22-13215 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c COLLISION REP FIT 1591971 CASE 22-13215 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS OZ STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 12 - 1-- 2022 1254 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 4TH STREET BLOCK NO. e✓ 4000 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 20 00 FMILES N EET e S ❑ E e UNION AVE NE 0 4 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2067885407 2 01 30 6� LAST NAME TRAN FIRSTNAME VAN MIDDLE K 1 1 2 31 INITIAL STREET ❑ 2500 81 ST AVE SE#305 CITY MERCER ISLAND ST WA 2jp, 980400000 z NEW ADDRESS 7❑ COL 1/ I IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑ 3 LICENSE CFJ7086 sTArI WAvIN# KNDPVCAG4P7029483 10 F91 PI ATE# TRAILER STATE TRAILER STATE 11 1 5 PLATE# PLATE# FROM TO TRLR. A'RLR. 1 3 33 12 1 5 VIN#' VIN# >; FROM TO VEH.YEAR 2023 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34 13 4 KIA SPORTA UT DAMAGE YES NO YES[:] No ✓ REGISTERED OWNER INFO .TRAN 250081STAVE SEAPT305 MERCERISLAND WA 98040 VEHICLE NO. 1 ❑ ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE Z INSURANCE CO GEICO 6114-82.48.70 3 4 IN EFFECT &POLICY# 9TOP 36 VE—L' CHARGE 1 5 ECALLv ❑NO❑ CITATION# 1 o BOTTOM 15❑ L STANDING YES 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2066841705 16 a LAST NAME JOHNSON FIRST NAME WILLIAM MIDDLE H INITIAL 17 STREET❑ NEW ADDRESS❑' 3522 S KENYON ST CITY' SEATTLE ST WA ZIP 98118 4❑ 37 18❑ CDL ., IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YEs t l NDF- 19[-] DRIVER# STATE WA SEX M M D.C.B. 02 _ 18 _ 1959 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 LICENSE I ❑21❑ PLATE# C5576C TArE 41 WA VINE 15GGD2714K3193390 1 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ 43 TRLR RLR VIN#. IN#. VEH YEAR 2019 MAKE GILL MODEL TRANSIT STYLE BU VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO KING COUNTY DEPARTMENT KING COUNTY DEPARTMENT 12200 E MARGINAL WAYS TUKWILAWA98168 D:2066841705 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU8 PORGY#E CO 74411051011VTIN 1 9TOP 5 VE—LE ❑ ,J� $ 'CITATION# CHARGE 25 i o BOTTOM LEGALLY YES N`L J 7MICAELA NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 CASTAIN 1 12573 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. ED14914 COLLISION REPORT III III III III III 111 1591972 CASE# 22-13215 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 POS. USE CLASS NAME '(LAST,FIRS 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' On 12-14-2022 at approximately 1254 hours I was dispatched to a collision at the intersection of NE 4th Street and Union Ave NE, in the City of Renton, King County, WA. Upon arrival, I contacted both parties. Each party disagreed on the incident. Unit 1 advised me that he made a left-hand turn from the driveway around 4004 NE 4th Street (north side of NE 4th Street), onto NE 4th Street traveling eastbound. Unit 1 advised Unit 2 changed lanes into the middle turn lane too early, causing unit 1 to collide into Unit 2 from the rear. Unit 2 advised me that he was traveling eastbound in the middle turn lane on NE 4th Street, preparing to make a left turn onto Union Ave NE. Unit 1 collided into Unit 2 while he was traveling in the middle turn lane. Unit 2 advised he was already in the middle turn lane when hit from the rear. There is damage to Unit 1's passenger front panel/bumper. There is damage to Unit 2's driver side rear panel. This concludes my involvement with this case. I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer M. Castain #12573 12/14/2022 Renton, King County, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAELA CASTAIN 12-14-22 02:03 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 12/15/2022 3:34:22 PM BADGE OR ID# 12573 ORI# WA0171300 TIME POLICE DISPATCHED; 12:54 PM TIME POLICE ARRIVED 12:54 PM PART I PAGE IT]OF 4� SUPPLEMENTAL REPORT No. ED14914 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE#1 22-13215 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓ G UNIT# 2 USDOT ICC# 7441 VEHICLE TYPE 1 CARGO 6ODY 1 ;TYPE 2 ❑ 1 28 CARRIER KING COUNTY DEPARTMENT OF NAME 3 CARRIER ADDRESS 12200 E MARGINAL WAYS CITY TUKWILA ST WA ZIP'', 98168 4 ❑ NAME # PLACARD: :❑ SOURCE 3 AXLES 04 GwvR 3000 + NAME IF NO NUMBER 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES NO i MIDDLE'... 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW AnnRFrtP. CITY ST ZIP 6 � CDL GNITIttN REQUIRED GNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES❑N0� vES N LLIICIENSE STATE I SEX M��DYRYY' 2 7 F-1 ON DUTYl STATUS AIRBAG' RESTR. EJECT HELMET INJURY NATURE OF INJURIES USE CLASS 8 ❑ ' 1 32 LICENSE+ rar VIN.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS T SABLIN TOWED BY anvi vEHIG P FROM TO DAMAGE Y EES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREETIAL ❑ 16 NFln+AnnRFs.� CITY'. ST SIP CDL IGNITION REDUIRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MICAELA CASTAW 12-14-22 02:03 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OR ID# 12573 O#I',WA0171300 JACOBS 12115/202 PAGE�OF 4 3000-345-013(R 11118) REPORT NO.! ED14914 CASE# ' 22-13215 DATE AND TIME 12/14/22 12:54 OF COLLISION NE 4TH STREET lommmmmmmmmmmmmolow z. m z m PAGE 4 OF 4