The URL can be used to link to this page

Home My WebLink About22-13909 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 22-13909 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ COLLISION.. 12 - 1-— 2022 1733 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ MAPPLE VALLEY HWY BLOCK NO. e✓ 15300 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 200 00 FMILES EET e S ❑ E e 152ND AVE SE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/NO D:2069491104 0 81 30 6❑ LAST NAME DOMPIER FIRSTNAME PATRICIA MIDDLE A 1 1 2 31 INITIAL STREET ❑, 11436 SE 208TH ST SPC9 CITY KENT ST WA ZIP 98031 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'F MID .O B 04 1- 30 - 1951 2 32 —' [NATURE OF INJURIES 9 ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 . EJECT 1 HELMETU E 2 CLASS'NJURY7 I CUT TO LEFT HAND z❑ 3 10 1❑ LICENS P1 ATE 14 CBX9906 sTAr WAv N# 7MUDAABG4NV005825 0 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 0 0 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE J 9 34 13 4 2022 TOYT COROL DAMAGE vEsNo � �MEYERS YES[:] No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 922106377 3 4 IN EFFECT &POLICY# 9TOP vEcnLLv HICLE 5 36 Yes❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ LE STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2065713177 16 2 LAST NAME SCRIBNER FIRST NAME CHRISTOPHER MIDDLE A INITIAL 17 NEW STREETREs7' 19533 SE 241 ST P! CITY' COVINGTON ST WA ZIP 98042 37 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19 DRIVER'S STATE I WA SEX M D.C... 01 07 1965 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40 USE CLASS WHIPLASH,HEADACHE ❑21❑ PLATE# C42471D TArE 41 WA VIN1 1GCHK24UX2E203375 1 42 22❑ PILER LATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. TOWED BY GOV HI 44 VEH YEAR 2022 MAKE CHEV MODEL SILVERA STYLE DAMAGE TOWED NO✓O YES NO 1/ 24❑ YES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO TRAVELERS PROPERTY CASUALTY COMPANY 8 1 0 61V54 7 344 2 214G STOP IN EFFECT VE""LE CITATION# CHARGE LEGAL 25 i o BOTTOM LY YES Nu ❑ s e 7.111-RlNAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26ETON 12047 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED37015 COLLISION REPORT III III III III III 111 1591972 CASE# 22-13909 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) EIDERIEN MICHELLE (LAST FIRST, ADDRESS&PHONE# D O.B. 19533 SE 241 ST PL COVINGTON WA 98042 2065713177 SEX F MMDDYyry 09 - 10 - 1969 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS❑ UNIT# 2 POS. 3 AIRBAG,2 RESTR. 4 EJECT 1 USE 2 CLASS 6 COMPLAINT OF HEAD,BACK,AND LEG NAME '(LASIE FIRS' MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX MMDDYYVY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY POS. NATURE OF INJURIES USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&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. C.LITTLETON 12-30-22 07:41 PM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 2/24/2023 5:50:02 PM BADGE OR ID# 12047 ORI# WA0171300 TIME POLICE DISPATCHED 5:36 PM TIME POLICE ARRIVED',5:43 PM PART I PAGE IT]OF REPORT NO. ED37015 CASE# 22-13909 OF COLLISION 12/30/22 17:33 OF CbLLI510N NARRATIVE All vehicles were traveling west on Mapple Valley Hwy approaching 152nd Ave SE in the left lane. Vehicles 2 and 3 were stopped for a red light when Vehicle 1 rear ended Vehicle 2. After being rear ended, Vehicle 2 rear ended Vehicle 3. Driver of Vehicle 1 stated she did not see Vehicle 2. She complained of some hand/wrist pain and had a small cut to her left hand. Driver Vehicle 2 stated he had a headache was feeling pretty foggy. Passenger of Vehicle 2 complained of head, lower back, and leg pain. Rear window of Vehicle 2 was shattered from accident. Driver Vehicle 3 did not complain of any injuries. Renton Fire arrived and evaluated all parties. Passenger of Vehicle 2 was transported to VMC as a precaution. I provided all drivers with the case number and all parties' insurance information. Driver of Vehicle 3 was cited for following too close. My BWC as on for this incident. On 1-6-23 1 learned I accidently cited the driver of Veh 3 for the wrong violation (following too close a fire apparatus ) instead of just (following too close). I emailed Renton Court and asked them to void the citation. Once 1 learn of the voided citation I will cite appropriately. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED3701 5 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT (CASE# 22-13909 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:2062906055 0 8 29 LAST NAME BAIN FIRST NAME CHRISTOPHER MIDDLE I F INITIAL STREET ] r:j 30 NEW AnDRFSP 4526 51ST PL SW CITY SEATTLE ST WA ZIP 98116 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs NO NTERLOCK YES❑N0� vES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 01 - 17 - 1960 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE CFG0085 TAr WA VIN# 2GNALDEKOC6117271 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN It VIN.#. 11 0 0 VEH.YEAR2012 MAKE CHEV I MODELEQUINOX STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vEH1I' P FROM TO DAMAGE YES 'E YES NO REGISTERED OWNER INFO OWNED BY DRIVER J 9 33 12 � SHADE IN DAMAGED AREA 34 FROM TO LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 953210748 GQO IN EFFECT &POLICY#VEHICLE 34 13Lecnuv YES NO❑ CITATION# CHARGE STANDING } 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNER YE YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ ET 16 STRETRE "F ' CITY ST ZIP NEW CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ ❑ 41 TRLR TRLR 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 AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEGALLv 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. C.LITTLETON 12-30-22 07:41 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 OI BADGE 12047 O#I',WA0171300 APPROVED BY 2%2E4/2023 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. ED37015 CASE# ' 22-13909 DATE AND TIME 12/30/22 17:33 OF COLLISION Mapple,Valley Eery m 4 PAGE 5 OF 5