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Home My WebLink About23-5076 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 23-5076 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 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cowsloN 05 - 1-- 2023 0937 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SE CARR RD BLOCK NO. e✓ 10700 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 200 00 FEET MILES e S ❑ W e 108THAVESE 2 0 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:2065191281 0 11 30 6� LAST NAME MONTIEL FIRSTNAME XITLALY MIDDLE 1 2 31 INITIAL STREET ❑ 227 D ST SE CITY AUBURN WA NEW ADDRESS ST ZIP 98002 II z 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO 1/ INTERLOCKYEs NOF,/ YES R No�/ 8 LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 CLASS NATURE OF INJURIES z❑ 3 LICENSE CGH9798 STATE WA VIN#' WBAVC73568KP38962 10 9❑ Pr ATE� TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR. 7 2 33 12 3 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR 2008 MAKE BMW MODEL 328 STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34 13 8 DAMAGE YES NO YES : NO REGISTERED OWNER INFO XITLALYMONTIEL 227 D STSE AUBURN WA 98002 D:2065191281 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO 2 4 IN EFFECT &POLICY# 9TOP VEH CHARGE 1 5 36 YEs No clTAnoN# OP MOT VEH W/OUT INSURANCE,NO o eorroM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2062475477 16 a LAST NAME BAKER FIRST NAME HASSAN MIDDLE INITIAL 17❑ STREET ❑', 5030 163RD PL SW CITY' EDMONDS ST WA ZIP 98026 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES t l NOF,/ 19[—] LDI IVER # STATE WA SEX U M D.C.B. 01 02 _ 1981 0 39 HELMET {NJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑ 21❑ LICENSE I C75266Z TATe WA VIN1t 1GCUYEED6NZ225805 ❑ 41 PLATE# 42 22❑ PILER LATE# STATE pLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' VEH YEAR 2022 MAKE CHEV MODEL SILVERA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO�/ YES NO�/ REGISTERED OWNER INFO HASSAN BAKER 5030163RD PL SW EDMONDS WA 98026 D:2062475477 VEHICLE NO.2 SHADE IN DAGED AREA 4 LIABILITY INSURANCE INSU PORGY#E CO PROGRESSIVE 03927777-1IN I 5 VEHICLELLY ❑ ,.I—I CITATION# CHARGE 25 GQ LEGA YES N`LJ s � e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 QU/NT TIBEAU 07691 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED57617 COLLISION REPORT III III III III III 111 1591972 CASE# 23-5076 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) NGWASI KALEMBO EUNICE T (LAST FIRST, ADDRESS&PHONE# D O.B. ' 7520 10TH AVENUE CT E APT B TACOMA WA 984045623 2536179556 SEXi F MMDOYyry 10 - 14 - 1979 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ ❑ 3 POS, ! 3 2 4 1 USE 2 1 CLASS ,1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# D O B 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.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. QUINT TIBEAU 05-05-23 04:20 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT D.SKELTON 9139 5/6/2023 4:09:55 AM BADGE OR ID# 07691 OR]# ! WA0171300 TIME POLICE DISPATCHED; 10:04 AM TIME POLICE ARRIVED',10:11 AM PART I PAGE IT]OF 5� REPORT NO. ED57617 CASE# 23-5076 OF COLLISION 05/05/23 09:37 OF CbLLI510N NARRATIVE 23-5076 Narrative The following occurred in the City of Renton, County of King, State of Washington. On 05/05/23 at about 1004 hours I was dispatched to 108th Ave SE and SE Carr Rd for a report of a three-vehicle collision. I arrived at about 1011 hours. I contacted the driver and passenger of vehicle #3, who stated that vehicle #1 was behind them in the middle lane of SE Carr Rd. Vehicle #1 then attempted to get into the left turn lane, striking the right side of vehicle #2 which was already in the turn lane. Vehicle #1 then struck the left side of their vehicle as she passed by. The driver of vehicle #2 stated that he had gotten into the left turn lane and was passing by vehicle #1 when she attempted to get into the left turn lane as well, striking his vehicle. Vehicle #1 then bounced off of his vehicle and struck vehicle #3. The driver of vehicle #3 identified herself as Xitlaly Montiel (02/12/2003) with her WA ID card. She stated that she did not have a driver license or insurance. Montiel stated that she was driving in the middle lane of SE Carr Rd and vehicle #3 was behind her. She attempted to get into the left turn lane and struck vehicle #2. She did not know how she could have damaged vehicle #3 as it was behind her. The damage to the vehicles appeared new and matched up to what I was informed by the drivers of vehicle #2 and #3. This incident was captured on my Axon body worn video camera. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. Nothing further at this time. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Q. Tibeau 05/05/23 1142 hours, Renton, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. ED57617 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-5076 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 UNIT# 3 �✓ � PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ D:2064683321 rFO 1 29 LAST NAME BONGOY LIMBANGI FIRST NAME : TATHY MIDDLE INITIAL STREET 30 NEW AnDRFrtP 1752 SW 345TH PL CITY FEDERAL WAY ST WA ZIP 1 98023 6 [2 1 1 2 31 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO✓ zERLOCK YES❑N0 f✓ YES N ✓ DRIVER'S LICENSE STATE I WA SEX M MMDDYYv', 05 - 28 - 1977 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE CCL5144 TAr WA VIN# 2T3MWRFV5KW009475 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1G P FROM TO 2019 TOYT RAW DAMAGE YES NO ✓ YES NO ✓ 33 REGISTERED OWNER INFO.TA THY SONGOY LIMBANGI 1752 SW 345TH PL FEDERAL WAY WA 98023 D:2064683321 ] $ 12 SHADE IN DAMAGED AREA 7GQ j4 FROM TO LIABILITY INSURANCE INSURANCE CO ALLSTATE 820311607 IN EFFECT &POLICY#EHICLE 34 13LEGALLY YES❑ NO❑ CITATION# CHARGE STANDING } qg 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STREET"[-] 16 NEW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLUCK YES No NTERLOCK 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 VIN# PLATE# rnr 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 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 AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv 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. QUINT TIBEAU 05-05-23 04:20 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 07691 O#IL WA0171300 SKELTON 5/6/2023 PAGE F OF 5 3000-345-013(R 11118) REPORT NO. ED57617 CASE# 23-5076 DATE AND TIME 05/05/23 09:37 OF COLLISION AN Nat is s:..a1:. PAGE 5 OF 5