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Home My WebLink About22-11747 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c COLLISION REP FIT 1591971 CASE 22-11747 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 2 TOTAL#OF OBJECT 1 0 4 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# COLLISION.. 11 - 1-— 2022 1055 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ RENTON AVE S BLOCK NO. e ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e TAYLOR AVE NW 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES ✓NO D:4259702130 0 6 30 6� LAST NAME LIM FIRSTNAME MARTIN MIDDLE S 1 1 2 31 INITIAL STREET ❑ 6955 S RUSTIC RD CITY SEATTLE HEIGHTS ST WA ZIP 98178 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs Z/NO YEs 1/ NO 8❑ LRIIVER # ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 . EJECT 1 HELMETU E 2 CLASS INJURY6 [NATURE OF INJURIES HEAD PAIN AND NECK PAIN z❑ 3 10[1P1 ATNES# C75827V sTAr WAV N# 1 FTEY15Y2SNA26565 0 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO TRLR. TRLR. 5 1 33 12 0 0 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T k GOVT.VEHICLE 34 13 4 1995 FORD F150 TR DAMAGE YES NOBS 7 3 YES[:] ✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 4 INSURANCE CO 3 4 14 IN EFFECT INSURANCE FARMERS 193969871 IN EFFECT &POLICY# 9TOP VEH" CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 10 BOTTOM 5 15❑ STANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE. ❑ ❑ : OWNER ❑ YES 1/ NO D:2062358911 16 a LAST NAME BRASEL FIRST NAME ROSS MIDDLE F INITIAL 17 STREET NEW ADDRESS❑' 6602 129TH PL SE CITY' BELLEVUE ST WA ZIP 98006 4❑ 37 18� CDL ., IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19[ DRIVER'S STATE WA SEX M D.C.B. 04 27 1962 39 LICENSE# MMCDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40 ❑LICENSE I 21❑ PLA E# C78707K TArE WA VIN1t 1XKDD49X09J251903 41 1 42 22❑ TRAILER HU17845 STATE OR TRAILER STATE PLATE# PLATE# 23❑ VIN#. 43 TRLR RLR 'IN#. TOWED eY Gov H 44 VEH YEAR 2009 MAKE KEN MODEL TRAC STYLE SE DAMAGE TOWED✓ NOO BLIN N/A YES N.7 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE I PORGY#E CO WESCO INSURANCE CO.WPP195780700 STOP 5 IN EFFECT VE—LE ❑ ,J� CITATION# CHARGE 25 io BOTTOM LEGALLY YES N J ' a =TURNER NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 12650 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED43639 COLLISION REPORT III III III III III 111 1591972 CASE# 22-11747 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. JASON TURNER 11-06-22 03:14 PM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOSS 1953 311912023 1:50:09 PM BADGE OR ID# 12650 ORI# WA0171300 TIME POLICE DISPATCHED! 11:00 AM TIME POLICE ARRIVED',11:06 AM PART I PAGE IT]OF 5� REPORT NO. ED43639 CASE# 22-11747 OF COLLISION 11/06/22 10:55 OF CbLLI510N NARRATIVE On 11/06/2022 at 1100 hours I was dispatched to the intersection of Renton Avenue S and Taylor Avenue NW for an unknown injury accident. Dispatch stated that the involved vehicles were a semi- truck and a pickup truck. When I arrived on scene, I observed a semitruck parked in the middle turn lane of Renton Ave S. I observed the pickup truck in the right lane of Taylor Avenue NE just north of the intersection. I met with the registered owner and driver of the pickup truck(unit2): Martin S. Lim DOB: 03/14/1990. The truck was a purple Ford F-150 (WA LIC: C75827V VIN: 1 FTEY15Y2SNA26565). Martin expressed pain in his head and pain in his neck. He was evaluated by fire and taken by ambulance to be evaluated. The F150 had extensive damage to the driver's side of the vehicle. The truck was towed. I met with the Driver of the semitruck (unitl): Ross F. Brasel DOB: 04/27/1962. The semitruck was a Kenworth Trac (WA LIC: C78707K VIN: 1XKDD49X09J251903) registered to Allen Van Lines. Ross reported no injuries. The semitruck had damage to the lower front end of the vehicle. Both parties explained the same story. Unit 2 was traveling northbound on Taylor Avenue NE. Unit 2 had a green light and was driving through the intersection when struck by Unit 1. Unit 1 was traveling east bound on Renton Avenue S. Unit 1 was approaching a redlight and attempted to stop but skidded through the intersection, colliding with Unit 2. 1 certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electrically signed by Officer J. Turner/ 12650 on 11-06-2022 at 1512 hours in the City of Renton. PAGE 3 OF 5 SUPPLEMENTAL REPORT No. ED43639 r`) POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 22-11747 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE G UNIT# 2 USDOT ICC# VEHICLE TYPE 4 CARGO BODY 9 TYPE 2 ❑ CARRIER 1 28 ALLIED VAN LINES NAME....... 3 CARRIER ADDRESS 8521 S 190TH ST CITY KENT ST WA ZIP'', 98031 4 ❑ NAME # PLACARD: :❑ NAME IF NO NUMBER SOURCE 3 1 AXLES 03 GI 18000 + 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 NEW AnnRFrtP. CITY ST ZIP 6 3 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YES No zERLOCK YES E]NO� 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 DAMAG EE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO ((ABILITY 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 STREET"[—] ❑ 16 NEn+AnnRFs.�' CITY'. ST SIP CDL IGNITION REdUiREO IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYSYY 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 TOWED 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 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. JASON TURNER 11-06-22 03:14 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OR ID# 12650 O#I',WA0171300 JACOBS 3/19/2023 PAGE�OF 3000-345-013(R 11118) REPORT NO. ED43639 CASE# ' 22-11747 DATE AND TIME 11/06/22 10:55 OF COLLISION z 2 <C ro' E- Renton Avenue S ffiffi .....v.�, y ...n....y�y Y e�.e�.e�...yry•ry•ry•ry•ry•ry•4�y imV B 00�� @@ I ��@��@�@ ,bg,. PAGE 5 OF 5