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Home My WebLink About23-4913 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-4913 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 2$ 0 5 RESERVATION TRIBAL UNITS 03 STRUCK z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 05 - 01 - 2023 1725 17 ❑. S 8 W Li OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ S 43RD ST BLOCK NO. e --- 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ �.❑ FEET e S ❑ W e DAMS AVE S 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2065815790 1 2 30 6❑ LAST NAME JAN FIRSTNAME SARDAR MIDDLE B 1 1 2 31 INITIAL STREET ❑ 605 S 18TH ST TON WA NEW ADDRESS S7 ZIP 96055 2 CITY REN 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/ 8 LDRIVER # STATE WA SEX'M MM ovY 09 1- 03 - 1954 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 2 EJECT 1 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 ,OF P1 ATNES# AFD5027 sTAT WA V N# JT2ST63C5G7021347 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# Rom ro TRLR. TRLR 7 3 33 12 1 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 3 34 13 A 1986 TOYT CEL/CA SD DAMAGE YES NO YES[:] No✓ REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE U NSURANCE CO HARP 55PHK85067t 4 IN EFFECT &POLICY# 9TOP VEHICLE CHARGE 5 36 LEGALLv Yes❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2539069999 16 a LAST NAME LI FIRST NAME GANG MIDDLE INITIAL 17 STREET I❑ s❑' 2700 MORRIS AVE S CITY' RENTON ST WA ZIP 98055 4❑ 37 NEW ADDREs 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/ 19 DRIVER'S STATE WA SEX M D.C.B. 10 _ 30 _ 1978 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40 ❑LICENSE I 21❑ PLA E# CCN5139 TATE 41 WA VIN# 4T1G118K4NU061766 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GI VEH YEAR 2022 MAKE 7'Dy7' MODEL CAMRY STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44 24❑ ES REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO pROGRESSIVE 926426926IN STOP 5 VEHICLE YES[:] N C[:] CITATION# CHARGE i o BOTTOM LEGALLY 0( 25 a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 BLAKE BOWIE 12105 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT No. ED56354 COLLISION REPORT III III III III III 111 1591972 CASE# 23-4913 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' On 05-01-2023 at 1735 hours I was dispatched to the intersection of Talbot Rd S / S 43rd St, in the City of Renton, County of King, State of Washington, for a reported three vehicle collision. Upon arrival, I contacted the driver of Unit 1. Unit 1 stated he was in the left lane driving straight when Unit 2 tried merging into his lane from the lane just right of him. Unit 1 was unable to stop in time and hit his front right corner of his vehicle into Unit 2. Unit 1 had no injuries. I spoke with Unit 2. Unit 2 stated he was merging into the left lane but did not see Unit 1. When Unit 2 merged over he hit Unit 1 and it pushed his vehicle into Unit 3 which was just parked in traffic. Unit 2 had no injuries. I spoke with Unit 3. Unit 3 was parked in the middle lane waiting for traffic to start moving as the light was red up ahead. Unit 3 felt someone hit him from behind. Unit 3 had no injuries. I provided them all with an exchange of information that contained the case number for their records. I 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 B. Bowie / 12105 on 05-01-2023 at 1839 hours in the City of Renton. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. SLAKE BOWIE 05-01-23 06:40 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 51112023 11:35:37 PM BADGE OR ID# 12105 ORI# WA0171300 TIME POLICE DISPATCHED; 5:34 PM TIME POLICE ARRIVED 5:38 PM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT No. ED56354 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-4913 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:2069191739 0 7 29 LAST NAME PHAN FIRST NAME LIEM MIDDLE' ',, T INITIAL STREET 30 ❑ NEW AnDRFrtP 458 OCEAN SHORES BLVD NW CITY OCEAN SHORES ST WA ZIP 98569 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs NO zERLOCK YES❑N0� vES N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 01 - 13 - 1982 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE BWR5648 TAr WA VIN# 5YJYGDEE2MF091452 PLATE# 9 9] TRAILER TRAILER PLATE If STATE PLATE If STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2021 MAKE TESL MODELMODEL Y I STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1Ci P FROM TO DAMAGE YES NO YES NO 33 REGISTERED OWNER INFO OWNED BY DRIVER J 9 SHADE IN DAMAGED AREA 12 z 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO MUTUAL OF ENUMCLAW A850033t49 GQ IN EFFECT &POLICY# 1VEHICLE 34 13Lecnuv YES NO❑ CITATION# CHARGE STANDING S} 8 7 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME NITIAL ❑ 36 STREET 16 NEW An "[-] CITY ST ZIP CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ 39 LICENSE rnr VIN# PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE If STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO 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 ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LERICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEGALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. BLAKE BOWIE 05-01-23 06:40 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12105 O#I',WA0171300 APPROVED BY 511112023 PAGE F OF 4 3000-345-013(R 11118) REPORT NO. ED5 3 4 CASE# 2y4 13 DATE m°M\ O@O]g3 ]225 « : COLLISION < . .. . .. Tit S � \ 2 ^ � % Davis Ave GE 4 0 «