HomeMy WebLinkAbout23-3690 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-3690 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ H F E: LOCAL AOENC 3
HIT IT&RUN CODING
COUNTY RD � PRIVATE WAY � INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 04 - 01 - 2023 1530 17 ❑-= S 8 E IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO. e✓ 1900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FMILES EET e S B E e CEDAR RIVER PARK DR
2 3 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 UECLE ❑ CYCLE ❑ YES ✓NO D:2068566592 30
6� LAST NAME JACKSON FIRSTNAME KAESEM MIDDLE E 1 1 1 31
INITIAL
STREET 01 31512 46TH AVE S CITY AUBURN ST WA ZIP 98001 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10❑ PI ATE 14 C13653T STATE WA uN# 54DB4W1B1KS806108
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. YRLR. 8 4 33
12❑ VIN#' UIN#.
2019 ISU NPR HD UT pL RO�34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13 3 DAMAGE YES �/ NO YES[:] NO✓
REGISTERED OWNER INFO AARONS 11121642 PACIFIC HWY S KENT WA 98032 D:2068566592 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE Z INSURANCE CO GREENWHICH INSURANCE RAD943804902 4
IN EFFECT &POLICY# 9TOP
vEHicLE CHARGE 5 36
LECALLv YES❑NO❑ CITATION# BOTTOM
15❑ STAIN.D" 8 6
UNIT 02 VEHICLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER RTY ❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YES❑NOR INTERLOCK YEs❑NOF YES❑NO❑
19 LLIRIVERISTICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
�LEGA—
❑ C[:] CITATION# CHARGE i o BOTTOM
YES N
25 'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26EW TRAINO 12811 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52146
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3690
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MOBLEY WILLIAM
(LAST FIRST,
ADDRESS&PHONE#
1608 8TH ST NE APT 20 AUBURN WA 98002 2534800914 SEX M MMDOYyry 01 - 23 - 1976
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 POS. 3 2 4 1 USE 2 CLASS +1
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D 0.B
SEX MMDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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 TRAINO 04-02-23 05:08 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 411712023 5:44:41 PM
BADGE OR ID# 1Y899 ORI# WA0171300 TIME POLICE DISPATCHED! 3:34 PM TIME POLICE ARRIVED]3:37 PM
PART Ei PAGE IT]OF 4�
TIME
REPORT NO. ED52146 CASE# 23-3690 OF COLLISION04/01/23 15:30
NARRATIVE
On 04/01/2023 at approximately 1534 hours I was dispatched to a reported Traffic Accident in the
1900 block of Maple Valley Hwy, within the City of Renton, County of King, State of Washington. A
passing motorist called dispatch to report that a vehicle had gone onto the sidewalk and struck a wall
at this location.
The following was recorded on my department issued body camera:
Upon arrival, I observed an Isuzu delivery truck (WA Plate C13653T), in the #1 lane (far right) of
eastbound Maple Valley Hwy. The truck was on the sidewalk, and had struck a wall at this location,
sustaining moderate damage.
I contacted the driver, identified as Kaesem E. Jackson (02/02/1996) by his WADOL, and asked him
to describe what had occurred. Jackson stated that he was exiting onto Maple Valley Hwy Eastbound
from 1-405 NB. According to Jackson, when he got near the bottom of the ramp, the steering wheel
`locked up', and he was unable to straighten it out from the right hand turn it had been in. The vehicle
continued to the right, striking the wall.
Jackson and passenger William Mobley (01/23/1976), also identified by his WADOL, reported no
injuries.
The Isuzu sustained damage to the front right corner of the cab. I also observed the vehicle driveshaft
laying on the ground. It is unknown if this occurred before or after the collision.
I asked Jackson if he had any previous issues with the vehicle, he said he did not. Jackson said the
vehicle belongs to his company and had recently been in the shop for repairs.
Jackson had the vehicle towed from the scene. He was not cited during this incident.
Case for information only.
N/F.
PAGE 3 OF 4
REPORT NO. ED52146 CASE# ' 23-3690 DATE AND TIME 04/01/23 15:30
OF COLLISION
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