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Home My WebLink About23-4910 POLICE WASHING ON I jjjjj� JII�jj�111��$j jjj�1$111I 16 1 27 POLICE TRAFFITco REPORT No. ED56541 F 170 COLLISION REP FIT 1591971 CITY STREET FIRE CASE# 1 23-4910 2 INTERSTATE RESULTED F STOLEN ❑STATE ROUTE ❑ OTHER ❑ VIRC F I F LOCALAGENCI 4100 3 HIT&RUN CODING F 2 3 COUNTY RD PRIVATE WAY INVOLVED OF OBJECT 1 28 TRIBAL 03 STRUCK� RESERVATION 2 3 M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑ n - 1720 [jE] =.= SH WH OF N E IN 3 701 -1 1 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION MILEPOST [:] � 4a❑ NE 4TH STREET B 4004 LOCK NO. DDISTANCE OF(REFERENCE OR CROSS STREET) 5 30 MILES N E UNION AVENE F1 FEET ❑ SH w❑I F201 29 MOTOR Z PEDAL- El DAMAGE THRESHOLD MET PHONE — UNIT 01 VEHICLE CYCLE YES[,/]NO [ ] I D:4257571733 lo 11 30 6 LAST NAME I BRUNK FIRST NAME CAPITOLA MIDDLE J 1 F 2]31 INITIAL STREET E]1284INE4CT CITY RENTON ST I WA ZIP 98056 2 NEW ADDRESS I I I I - �GNITION PRESENT MEDICAL TRANSPORTED 7 CDL IGNITION REQUIRED 3 I I:NTERLOCK YES[:]NOV I�NTERLOCK YES[:]No✓ YESF-]NO [ DRIVERS STATE I WA I-SEXIF I D, ---] 1 K21 32 8 LICENSE# I I 00y�y -H -Ff 9 7 9 I HELMET ------T [NATURE OF INJURIES 2❑ 9❑ STATUS AIRBAG 2 RESTIR 4 EJECT 12 1 INJURY 7 USE CLASS I'7 I NECK PAIN LICENSEI CHA2476 WA KNDJ23AU9P7870834 3 loFg-1 I PI ATF to ISTATE I I VIN#1 p—�5 1 TRAILER STATE LATE# PLATE#TRAILER STATE ROM T. I F---l— —TWITI — TRLR 7 3 33 2 3 5 VIN#j VIN#j 1 1 FROM T. VEFLYEAR 2023 MAKE KIA MODEL SOUL STYLE P2 VEHICLE TOWED 2 TO ffBLINI TagWgyMyERS GO DAMAGE YFVT V 13 I I AMA E YES NO _Sl:l Hil 34 REGISTERED OWNER INFO FINANCE KIA PO BOX 101299 ATLANTA GA 30348 VEHICLE NO, 1 ❑ n SHADE]IS DAKMOE�D AREA 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO STATE FARM 4450757-AI5-47A IN EFFECT &POLICY# VEH'CLL YES[:]NO❑ CITATION# CHARGE 36 LEGA L'Y, 15❑ 2 1 STANDING MOTOR PEDAL- ❑ ❑ PROPERTY ❑IDAM VTHRrl OLD MET PHONE UNIT 02 VEHICLE CYCLE PEDESTRIAN OWNER YES NO D:4256521676 16 LAST NAME AYALAMANCILLA FIRST NAME AGILEO, MIDDLE I I I I INITIAL 17❑ STREET TON AVE NE CITY RENTON ST WA ZIP I M� 4] 37 1 NEW ADDRESS SHEL I I I I I 18 IGNITION REQUIRED JIGNITION PRESENT MED CALTRANSPORTED 38 CDL :ERLOCK YESF-]NoF,/II INTERLOCK yEs F�.okZ YE$F NO F,/:n 1�1 — STATE WA P07 U—I 39 19 1 DRIVERS ]SEXIM MMDDYY --W74 LICENSE# F � 20 F1 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 12 1 'INJURY 1 7 NATURE OFINJURIES 40 [:]I I I I I I I I I USE CLASS BACKPAIN LICENSE 1647XWC TATE WA IN# 4TIB846K59U078438 ❑ 41 21❑ PLATE# V 1 I I I I I 42 22❑ ITRAILER I STATE I I TRAILER I STATE PLATE# PLATE 23 43 ❑ FTRURT �RLR VIN# J Il IN# 44 VEH,YEAR 2009 IMAKE TOYT 'AM MODEL CAMPY STYLE P4 jVEHlAC.LEE TOWEDMT.ffBLINj TOWED8 JG.VHI Yr 24❑ ��, NO GENE MYERS YES REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE N•O.2 SHADY DAd OED AREA LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 2008835319 IN EFFECT &POLICY# VE"LE CITATION# CHARGE 25 LEGALLY YES 1:1 Nu I I NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY SCOTT 10272 WA0171300 26 1 � PARTA :,.00-345-159 OR 11/1M PAGE 01 OF TON STATE ICE T AFFIIC CORRECTIONREPORT . ED56541 COLLISION a��c� 1591972 CASE# 23-4910 AWTIONAL PERSONS INVOLVED(PASSENGERS ANWOR WfTNESSES ONLY) tNll:: BUTLER CLIFF R MIDDLE INITIFvl.? ADDFJ,$5 3 P&VCNE 0... 2841 NE 4TH CT RENTON WA 98056 4257571733 SEX M wIM Brvx 07 16 1973 SEAT HELMET M JURY NATURE OF INJURIES PASSENGER 21 WITNESS❑'11 UNIT0 1 EA 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS '7 BACKPAIN NAME sT FIRsr MIDDLE INMAL) MCALLISTER COFFY T ADDFIESS&PHONE# 15110 MACADAM RD S#A103 FEDERAL WAY WA 98188 2065910187 SEX U MUDDYWYY 10 _ 25 _ 1976 SEAT HELMET INJURY FIA USE GF INJURIES PASSENGER �WITNESS UNIT u 3 3 AIRBAG 2 RES�R. 4 EJECT 1 2 7 POS. USE CLASS BACK PAIN (L4.^T FIRSY'.MOOLE IN8%'IAQ AD SS S.PHONE' SEX D.Q.B. PASSENGER WTNESS❑ UNIT# S III AIRBAG RESTR, EJECT HEiLM SEET flNJOY NATURE cF INJURIES RIONARRATIVE' On 5/01/2023 around 1722 hours I was dispatched to 4004 NE 4th ST (City of Renton, County of King, and State of Washington due to a report of a vehicle collision. Upon arrival I contacted Driver#1 who stated she was in Lane #2 going East bound on NE 4th Street when she realized she needed to be in the turn lane. Driver#1 merged into the turn lane, LANE #3 and did not see Vehicle #2 in the lane. Driver#1 had merged into Vehicle #2. The impact of the collision pushed vehicle #1 back into lane 2 and then into lane #1 where Vehicle #1 one struck Vehicle #3. Driver#1 stated she had neck pain and passenger#1 stated he had back pain. Vehicle #1 sustained damage to its driver's side front bumper, quarter panel and driver's door, from the 1 st impact. The second impact Vehicle #1 sustained damaged to the front passenger quarter panel. Vehicle #1 was towed by Gene Myers towing. Driver#1 stated he was in the turn lane, LANE #3 headed East bound on NE 4th Street when Vehicle #1 turned into him. Vehicle #2 sustained damage to its hood, wheel door and front side panel on the passenger side. Driver#2 complained of back pain. Vehicle #2 was towed by Gene Myers towing. Driver#3 stated he was in lane #1 when vehicle #1 was involved in a collision in lane #2 that then pushed Vehicle #1 into his lane #1 striking Vehicle #3. Vehicle #3 had damage to its driver's side rear quarter panel and bumper. Passenger#3 stated she had back pain. Driver#3 also had back pain. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. DESIRES SCOTT 05-02-23 03:03 PM INVESTI ATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATEL) PLACE SIGNEE) APPROVED BY _.. _..... _ DATE _... DESIREE SCOTT 10272 1 512(2023 4:28:06 PM BADGE OR ID# 1 102272 GRI# WA0171300 TIME POLICE INSPATCHED; 5:22 PM TIME POLICE ARRIVED 5:25 PM PART_.B -346,160 MI1 18 PAGE 2.. OF.. 4 _. SUPPLEMENTAL REPORT No. ED56541 .}itPOLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE#; 23-4910 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY; TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER. ADDRESS ` CITY ST ZIP 4 ❑ NAME # PLACARD ❑ GWVR NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAM AGE THRESHOLD MET PHONE UNIT# 3 PEDESTRIAN YEs✓ No PHONE 462303 5 VEHICLE CYCLE OWNER 0 1 29 LAST NAME JONES FIRST NAME CAMREN MIDDLE: D INITIAL STREET 30 NFW Anr)PF4P.. 15110 MACADAM RD S#A103 CITY FEDERAL WAY ST WA ZIP 6 CDL IGNITION REt7UIRED IGNITION PRESENT MEDICAL TAN5PORTEO 1 1 2 31 INTERLOCK YEs NO Z/ INTERLOCK YES NOZ YES[:]N Z DRIVER'S LICENSE STATE I WA SEX'M MMDDv 05 - 28 - 2003 7 HELMET I INJURY NATURE OF INJURIES ON DUTY STATUS AIRBAG'' 2 RESTR. 4 EJECT '1 USE 2 CLASS 7 BACK PAIN 8 ❑ 1 32 LICENSE'CFE6496 TAr Wq VIN# 1G1155S35EU106172 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2014 MAKE CHEV I MODELIMPALA STYLE P4 VEHICLE TOWED DUE T SABLIN TOWED BY anvi vEHlci F FROM TO DAMAGE YES NO � YES NO [:::�] BOEING EMPLOYEE PO BOX 997500 SACRAMENTO CA 95899 ] 3 33 REGISTERED OWNER INFO. FHA ILL IN DA NlAG[O ARI,,A 12 1 FROM TO LIABILITY IN INSURANCE CO GEICO 6119-42.64.73 ✓ d rtt7 IN EFFECT ❑� aPoucv# o� 34 13 ❑ LE YES[:] NO❑ CITATION# CHARGE 3tp t i J441 LEGG LEY ALLY STANDING Y 14 ❑ KNIT# MOTOR PEDAL :1:1 PROPERTY M DAMAGETHRESHOLD MET PHONE ❑ 35 VEHIU E CYCLE PEDESTRIAN OWNER YES NO 15 LAST NAME FIRST NAME MIDDLE ❑ 36 ❑ ITIAL 16 STREET NFW AOf5RRF9❑ CITY ST ZIP CDL IGNITION REDUIRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YEs NO INTERLOCK YEs NO YEs NO. 17 4 37 LLIICENSE# STATE I 5EX MMDDYB`Y' - 18 ❑ HELMET INJURY ❑ ' NATURE OF INJURIES 38 ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS. 19 ❑ LICENSE rnr vIN# 39 PLATE# 20 ❑ TRAILER TRAILER ❑STATE 40 PLATE#. PLATE# STATE 21 ❑ ❑ 41 TRLR TRLR VIN#: VIN# 42 22 VEH.YEAR MAKE I MODEL STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ -98ADE IP4 DAMFACED ARF", 43 3 a LIABILITY INSURANCE INSURANCECO -' IN EFFECT &POLICY# h t F 44 VEHICLE 24 LEnILLE YES NO❑ CITATION# CHARGE "^,. LE ALLY ....^.mm^" STANDING '" I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. DESIRES SCOTT 05-02-23 03:03 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 BADGE R ID# 10272 O#I WA0171300 SCOTT 5/2/2023 PAGE[OF 3000-345-013(R 11118) REPORT NO. ED56541 CASE# ' 23-4910 DATE AND TIME 05/01/23 17:20 OF COLLISION PAGE 4 OF 4