HomeMy WebLinkAbout23-4364 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-4364 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
cowsloN 04 - 18 - 2023 1349 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE PETROVITSKY RD BLOCK NO. e✓ 12800 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 128THAVESE
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2539547757 0 11
30
6� LAST NAME HARDCASTLE FIRSTNAME PAULA MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 20901 91ST ST E CITY BONNEYLAKE ST WA ZIP 983916314 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
LICENSE CEC7318 STATE WA uN# 1B3ES56C44D636967
10 1❑ PI ATE�
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 3 ] 34
13 2 2004 DODG NEON 4D DAMAGE YES NOBS YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ❑ INSURANCE CO eq�T3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP 5
VEHCLE CHARGE 10 BOTTOM 36
LEGALLY YEs No CITATION# 3A0055618,3A0055618 NO VALID OPER LICENSE WITH
15❑ NDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2068416708
LAST NAME KEYES FIRST NAME KAREN MIDDLE K
INITIAL
17❑ STREET Is❑' 17005 137TH PL SE CITY' RENTON ST WA ZIP 980587003 37
NEW ADDREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK YEsF-j No� YES
NoF
19 DRIVER'S STATE WA SEX F D.C.B. 10 _ 30 _ 1960 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# BJF4336 TATE 41
WA VIN KNDPCCA27D7391264 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2013 MAKE I(I/� MODEL SPORTAG STYLE (/T DAMAGE TO WED NOO✓ BLIN YES
NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO pROGRESSIVE71016067IN 1 9TOP 5
'E""LE ❑ N,J� CITATION# CHARGE
LEGAL i o BOTTOM
LY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW NUGENT 11498 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED52602
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4364
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 04-18-23 06:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 411912023 8:37:40 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED! 1:50 PM TIME POLICE ARRIVED 2:06 PM
PART I PAGE IT]OF 4�
REPORT NO. ED52602 CASE# 23-4364 OF COLLISION
04/18/23 13:49
OF CbLLI510N
NARRATIVE
23-4364
On 04/18/2023 at approximately 1350 hours, I was dispatched to a blocking vehicle collision at the
intersection of 128th Ave SE and SE Petrovitsky Road, within the City Limits of Renton, County of
King, State of Washington.
Upon my arrival, 1 confirmed there were no complaints of injury requiring immediate medical response
at the time of report. There, I was able to collect each involved party's information and independent
summary of the events leading up to the collision.
The driver of Unit#1 said she was the sole occupant of her vehicle and was traveling westbound in
about the 12800 block of SE Petrovitsky Rd and approaching the intersection of 128th Ave SE in lane
2 of 2. The driver of Unit#1 stated that she needed to get into the right lane (lane 1 of 2) to make an
upcoming right turn at the intersection. The driver of Unit#1 stated she had missed her turn
previously and was looking for a specific address when she began to merge over to the adjacent lane
next to her, specifically making a lane change from lane 2 of 2 to lane 1 of 2. The driver of Unit#1
stated that she believed Unit#2 would have seen her trying to change lanes. The driver of Unit#1
stated that while making the lane change, Unit#1 struck Unit#2 occupying lane 1 of 2 causing minor
damage to the front passenger side bumper and quarter panel of Unit#1.
The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling westbound
in about the 12800 block of SE Petrovitsky Rd approaching the intersection of 128th Ave SE but in
lane 1 of 2. The driver of Unit#2 stated she was intending to continue straight when Unit#1 changed
lanes from lane 2 of 2 and into lane 1 of 2 which Unit#2 was occupying. Unit#2 was unable to avoid
the collision and subsequently collided with Unit#1. Unit#2 suffered moderate damage to the driver's
side door and fender because of the collision. The driver of Unit#2 informed me that the driver of Unit
#1 appeared to be reading paper directions and was not paying attention to traffic around her.
Based on the above statements, 1 determined that the Driver of Unit#1 (Hardcastle) was the
predominant factor for the collision as Hardcastle made an unsafe lane change that was not clear of
traffic causing a collision. Hardcastle was listed as `Not Licensed -Eligible' per a DOL records check.
I cited Hardcastle in-person for NVOL -with Identification and Operating a Motor Vehicle without
Insurance. I issued Hardcastle a verbal warning for Inattention causing a collision.
Both Unit#1 and Unit#2 were 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 4/18/2023 6:38 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. ED52602 CASE# ' 23-4364 DATE AND TIME 04/18/23 13:49
OF COLLISION
N
'Eiagcam wt to scaEe
Unit#2
SE Potrovitsky Road
D
UUnI#1
rn
PAGE 4 OF 4