HomeMy WebLinkAbout23-2479 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-2479 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT&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# ❑
cowsloN 02 - 1-- 2023 0845 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
140TH WAY SE BLOCK NO. e✓ 15200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 615 00 FMILES N EET e S B E e MAPLE VALLEYHWY
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254443461 N:4254443461 0 9 30
6 LAST NAME STANFORD FIRST NAME ANN MARIE MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 1522 219TH PL NE CITY SAMMAMISH ST WA Zip 980746811 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ DRIVERS
E# STATE WA SEX'F MM DAY' 05 1- 19 - 1965 2 32
LICEN -' [NATURE OF INJURIES
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 . EJECT 1 HELMETU E 2 CLASS'NJURY7 I C/O BEING SHOOKEN UP z❑
3
10 99 P1ATE14 NUPAD4U sTAT WAuN# 4T1K31AK6MU549685
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM ro
FT -R TPILF1 1 5 33
12 4 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE g 9 34
13 2 2021 TOYT CAMRY 4D DAMAGE vEs 0NO agW�MEYERS vEs❑ No
REGISTERED OWNER INFO A.MARIE HAUSER 1512219TH PL NE SAMMAMISH WA 98074 D:4254443461 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILI V INSURANCE INSURANCE CO STATE FARM 481 5096-E23.478 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# W23010234 INATTENTIVE DRIVING 1 o sorrow
15❑ STANDING 7 6
1,1 MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES�/ No D:2063131183 N:2063131183
16 a
LAST NAME YU FIRST NAME XE MIDDLE Y
INITIAL
17 STREET I❑ s❑' 5106 NE 10TH PL CITY' RENTON ST WA ZIP 980594367 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVERS STATE WA SEX M M .C... 07 11 1984 39
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HE 2 INJURY 6 NATURE of INJURIES 40
USE CLASS C/O DIZZINESS
❑21❑ PLATE# CFU9305 TATE WA VIN# 41
7SAYGAEE7PF604331 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
TOWED BV Gov HI 44
VEH YEAR 2023 MAKE TESL MODEL MODE!Y STYLE (/T —VEHICLE
TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 817 649 174IN 1 9TOP
VE""LE CITATION# CHARGE i o BOTTOM
LEGALLY YES N�
25❑ s
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26 11498 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED38477
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2479
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.
MATTHEW NUGENT 02-28-23 04:23 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.MORR/S 2613 31112023 8:56:57 AM
BADGE OR ID# 11498 ORI#` WA0171300 TIME POLICE DISPATCHED 8:46 AM TIME POLICE ARRIVED',8:47 AM
PART I PAGE IT]OF 4�
REPORT NO. ED38477 CASE# 23-2479 OF COLLISION
02/28/23 08:45
OF CbLLI510N
NARRATIVE
23-2479
On 02/28/2023 at approximately 0846 hours, I was dispatched to a blocking vehicle collision with
reports of injury in the 15200 block of 140th Way SE (just south of the intersection at Maple Valley
Highway and 140th Way SE), within the City Limits of Renton, County of King, State of Washington.
While en route, Dispatch advised that Renton Regional Fire would also be dispatched due to
complaints of injury. Dispatch advised that two vehicles were reported to be involved and were
described as a black Tesla and a blue Toyota Camry.
Upon arrival, I contacted all involved parties and confirmed that one of the involved drivers was
complaining of dizziness and the other involved driver was complaining of being "shooken up".
Renton Regional Fire later responded to the scene and evaluated the involved parties. All parties
were treated at the scene and released. 1 collected each involved party's information and
independent involvement leading up to the collision.
The driver of Unit#1 said she was traveling southbound in the 15200 block of 140th Way SE in lane 3
of 3. The driver of Unit#1 stated she was traveling directly behind Unit#2 and begun reaching for her
sunglasses inside of the vehicle due to the sun glare on the roadway. The driver of Unit#1 did not
notice Unit#2 was stopped or slowing for traffic. The driver of Unit#1 stated that upon noticing, she
attempted to avoid the collision by braking but that her vehicle made contact with the rear of Unit#2
causing significant damage to the front of Unit#1.
The driver of Unit#2 said he was the sole occupant of his vehicle and was also traveling southbound
in the 15200 block of 140th Way SE in lane 3 of 3. The driver of Unit#2 stated that he was traveling
directly behind an uninvolved vehicle. According to the driver of Unit#2, the uninvolved vehicle
proceeded to brake suddenly and complete a U-turn. The driver of Unit#2 momentarily stopped for
traffic. While Unit#2 was stopped for traffic, Unit#1 collided with the rear of Unit#2 causing moderate
damage to the rear of the vehicle. The driver of Unit#2 later provided me with video footage from the
Tesla vehicle which has since been uploaded to this report. Some Tesla models offer video
"dashcam" footage from several different angles to provide coverage around the entire vehicle.
Based on the above statements, 1 determined that the Driver of Unit#1 (Stanford) was the
predominant factor for the collision due to Inattention. Unit#2 had the right of way and was yielding to
traffic in front when Unit#2 was struck by Unit#1 from behind.
I issued Stanford a Written Warning for Inattentive Driving causing a collision.
Unit#1 had to be impounded due to extensive damage. Unit#2 was able to be driven away without
further incident. An exchange of information was provided to all involved parties.
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. Nugent#11498 4:23 PM 2/28/2023 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED38477 CASE# 23-2479 DATE AND TIME 02/28/23 08:45
OF COLLISION
Maple Valley Hwy
t
OS
'Diagram not to scale r4 t
c
i
Unit#2
--- =Direction o9 Travel prior to impact �y
Unit#1
PAGE 4 OF 4