HomeMy WebLinkAbout23-2501 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-2501 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK OVER EMBANKMENT
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 03 - 01 - 2023 0604 17 ❑. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HIGHWAY BLOCK NO. e✓ 2003
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 0 1 29
UNIT MOTOR
E Z CYDALVEHICCLE ElDDAMYESA✓NOESHOLDMET PHONE Q 11
30
6� LAST NAME GROSSMAN FIRSTNAME SHERYL MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 15012 133RD AVE SE CITY RENTON ST WA 2jp, 98058 z
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/iNTERLOCKYEs NO INTERLOCKYEs Z/NO YES 1/ NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES z❑
USE CLASS RIGHT ARM/SHOULDERIUNKNOWN
3
10 Pl ATNFS# 016YZ0 STATE WA VIN#' JTEES41A482032315
----� TRAILER STATE TRAILER STATE11 0 0 PLATE# I PLATE# I I FROM To
TRLR. TRLR 1 5 33
vIN#
12 0 0 ' VIN#
FROM TO
VEH.YEAR 2008 TOYT HIGHLA UT MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES No �LII� RS YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 0510913205 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064077218
16 a
LAST NAME BERMANI FIRST NAME ALI MIDDLE H
INITIAL
17 STREET NEW ADOREss❑' 25708 160TH PL SE CITY COVINGTON ST WA ZIP 98042 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YES
❑NO/
19 LCENSE DIIVERI # STATE WA SEX M MMDDYY 11 7 30 _ 1982 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLATE# 61799D TATE WA vIN1 1FMCU9GD2HU668205 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2017 MAKE FORD MODEL ESCAPE STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO CITY OF SEATTLE 7005TH AVE STE 5200 SEATTLE WA 98104 D:2066848213 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POLICY#E CO CITYOFSEATTLEIN 1 9TOP
VEHICLE YES[:] ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY N
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ROSEANNE HYNES 12612 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED38550
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2501
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,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.
ROSEANNE HYNES 03-01-23 08:56 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 31112023 11:39:09 AM
BADGE OR ID# 12612 ORI# WA0171300 TIME POLICE DISPATCHED 6:08 AM TIME POLICE ARRIVED 6:14 AM
PART Ei PAGE IT]OF 4�
TIME
REPORT NO. ED38550 CASE# 23-2501 OF COLLISIONO3/01/23 06:04
NARRATIVE
On 03/01/2023 at 0608 hours, I was in full patrol uniform and driving a marked Renton Police patrol
vehicle when I responded to 1915 Maple Valley Highway in the city of Renton, County of King, State
of Washington regarding a traffic collision.
The comments in the call said in summary: Two vehicle accident, unknown injuries...locking unknown
direction of travel...nknown description of vehicle RP says too dark.
Upon arrival, I saw a vehicle in the embankment on the east side of Maple Valley Highway. It was in
front of 2003 Maple Valley Highway. The vehicle (V1) was a silver Toyota Highlander (WA LIC#
016YZO). V1 was facing a southeast direction. There was major front end damage. The rear tires
were in the water & mud of the embankment. Shortly after exiting my patrol vehicle, an unknown male
approached me and pointed to a woman in the embankment. The unknown male appeared to be a
good Samaritan that was not involved in the accident. As I attended to the female in the ditch, the
unknown male subject left the location.
I saw a female subject in the ditch. She was next to V1 and was stuck in the mud and water. The
female was later identified as Sheryl L. Grossman. Officer T. Nelson and 1 assisted in pulling
Grossman out of the water and mud until Renton Fire arrived. Renton Fire removed Grossman from
the embankment and placed her into an ambulance. During my contact with Grossman, she
appeared confused. 1 asked Grossman if she was driving the vehicle and what happened and she
repeatedly said, "no". I asked her what her name was and she said, "no". Grossman was unable to
provide basic information to me or medical personal on scene. V1 was unoccupied. It is unknown if
Grossman sustained injury as she was not able to verbally communicate with me. I observed that her
right shoulder may have been injured because of it's limited movement. Her injury is unknown.
I spoke with Reporting Person/Driver 2 (D2) Ali H. Bermani and he told me in summary: He was
driving his work vehicle (WA LIC# 61799D). He was driving north of Maple Valley Highway. He
pointed to where the accident happened on the roadway and it appeared to be in the 2000 block of
Maple Valley Highway. As he drove north in the left lane, V1 was driving south on Maple Valley
Highway. As V1 drove in the opposite direction of him, V1 swerved into the back of his vehicle and
veered off the roadway. D2-Bermani said his vehicle and called 911. He walked to where V1 was and
saw a male subject (good samaritan) attempting to pull the female out of the embankment. D2 said
he was not injured and declined medical assistance. I did not observe visible injury upon him. I asked
D2 if he saw who was driving V1 and he did not know. He also did not see Grossman exit the driver
seat. When he walked to V1, Grossman was already stuck in the water/mud.
I ran V1 and found that the vehicle was registered to Grossman. Grossman was positively identified
through her matching Department of Licensing photograph. Although Grossman is the registered
owner of V1, I was unable to determine if Grossman was driving the vehicle. No witnesses saw her
driving and nobody saw her exit the vehicle. In the event that Grossman was driving, it should be
noted that I did not observe anything that would lead me to believe she was under the influence of a
substance. I am not a medical professional, but it Grossman may have had an unknown medical
emergency, was injured and confused from the accident or both. V1 was not drivable and was towed
from the scene. A written impound form was completed. One copy was left with V1 and the rest were
given to Renton records.
I took photographs of the scene and of V1 and V2. There were no witnesses at the scene and I did
not see video cameras in the area. I have nothing further at this time.
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: R. Hynes #12612 Date & Place: 03/01/2023 @ 0820 hrs Renton, WA
PAGE 3 OF 4
REPORT NO. ED38550 CASE# 23-2501 DATE AND TIME 03/01/23 06:04
OF COLLISION
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PAGE 4 OF 4