HomeMy WebLinkAbout23-4478 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-4478 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS OS STRUCK' UT/LITYPOLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 04 - 1-- 2023 1900 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e✓ 19044 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e 190TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4257609983 0 11
30
6� LAST NAME GILBERSON FIRSTNAME DANE MIDDLE 1 2 31
INITIAL
STREET ❑ 24531 NE 8TH ST CITY SAMMAMISH ST WA ZIP 98074 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� CCT5970 sTArI WAurN# JNKCV51 E75M207487
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 0 0 VIN#' VIN#'
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 1 5 34
13 4 2005 INFI G35 DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO ALLSTATE807806858 4
IN EFFECT &POLICY# TOPVEHCLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STAIN,DIING 7 6
UNIT U2 VEHIMOTOCLE CYCLE ❑ PEDESTRIAN ❑ OWN A PEDAL RTY [:]EA.
✓ NO OLD MET PHONE
16 a
LAST NAME MWANGI FIRST NAME NEWTON MIDDLE N
INITIAL
17 STREET❑ NEW ADOREss❑' 4909 SOUTH OCHARD ST,APT C CITY TACOMA ST WA ZIP 98467 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DRIVER'S STATE WA SEX M D.C.B. O6 _ 05 _ 2001 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAU EY 6 COMPLAINT OF PAIN TO LEFT ARM ❑F—NATURE OF INJURIES 40
❑21❑ PLATE# CFW3005 TArE W 41
A VIN# 1HGFA16866L055992 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TIN# IN RLR
#.UIN#. '
VEH YEAR 2006 MAKE HOND MODEL CIVIC STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYERS YES NO✓
REGISTERED OWNER INFO NEWTON MWANG14909 SOUTH OCHARD ST,APT C TACOMAWA98467 VEHICLE NO.2
SHADEDAMAGEbAREA
s Cd
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP
VE""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
N AAH GIRELLO 12607 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED61924
COLLISION REPORT III III III III III 111
1591972 CASE# 23-4478
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.
NOAH GIRELLO 04-21-23 02:38 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 512012023 11:32:34 AM
BADGE OR ID# 12607 ORI# WA0171300 TIME POLICE DISPATCHED 7:02 pry] TIME POLICE ARRIVED',7:07 Pm
PART Ei PAGE IT]OF 7�
REPORT NO. ED61924 CASE# 23-4478 OF COLLISION
04/20/23 19:00
OF CbLLI510N
NARRATIVE
23-04478
At about 1902 hours on 04/20/2023 1 was dispatched to an accident with injuries at, 19044 108th Ave
SE, in the city of Renton, King County, Washington. Dispatch advised me that this was a four-car
collision with one vehicle striking a pole and injuries were unknown.
Unit 1 -Silver 2005 Infinity G35 (LIC/CCT5970) (VIN/JNKCV51 E75M207487)
Driver: Dane M Gilbertson (DOB 08/23/1988)
Unit 2 -White 2006 Honda Civic (LIC/CFW3005) (VIN/1 HGFA16866L055992)
Driver: Newton N Mwangi (DOB 06/05/2001)
Unit 3 -Silver 2008 Toyota Corolla (LIC/CFH0177) (VIN/1 NXBR30E48Z002930)
Driver: Abdul S Ghaznawi (DOB 12/30/1975)
Unit 4 -Black 2015 Lexus IS (LIC/BVN4026) (VIN/JTHCFI D26F5024911)
Driver: Abhi S Lehal (DOB 01/03/2001)
Unit 5 -Silver 2018 Kia Forte (LIC/BLS0633) (VIN/3KPFN4A8XJE166087)
Driver: Jacqueline M Mabry (DOB 08/09/1948)
Upon my arrival, myself and the other arriving officers blocked the roadway and checked for injuries.
The driver of Unit 2 was complaining of arm pain but had no obvious injuries, while all other drivers
had no injuries. Fire and aid were started to evaluate the driver of Unit 2 for his injuries.
It is important to note that at the time of this accident it was raining very hard, and the roads had been
wet for several hours. The first point of impact was on a downhill slope leading up to an intersection
controlled by traffic lights. I estimated the crash happened about 30 yard to the north of the
intersection.
I started by contacting a witness who did not stick around to be identified. The unidentified witness
told me that unit 1 was traveling at a high rate of speed going south on 108th Ave SE approaching the
intersection of 108th Ave SE and SE 192nd ST. The witness said he saw unit 1 strike unit 2 causing
and chain reaction of rear end collisions and sending unit 2 off the roadway and striking a utility pole.
The following is a summary of what Unit 1 said happened. Unit 1 advised that he wasn't sure what
happened because it happened so fast. Unit 1 said all he knew was that he was traveling south on
108th Ave SE, behind a black Lexus (Unit 4) and then he was hit by a car, but he did not know which
car. Unit 1 had severe damage to the front of his car. The front of his vehicle was the only area he
had damage.
The following is a summary of what Unit 2 said happened. The driver of unit 2 was very shaken up
from the crash and in pain from his injuries. He could not tell me what happened. Unit 2 had severe
damage to both the front and back of his vehicle, as if he was sandwiched between 2 vehicles. Unit 2
also ended up off the roadway where he struck a utility pole in the parking lot of the near by gas
station. There was no damage to the pole.
The following is a summary of what Unit 3 said happened. The driver of unit 3 also could not recall
much of what happened in the accident. Unit 3 was hit from behind which caused him to hit unit 4
from behind. Unit 3 had damage to the rear of his vehicle as well as the front passenger side.
The following is a summary of what Unit 4 said happened. The driver of unit 4 said that he was in
front of unit 1 traveling south bound on 108th Ave SE approaching the intersection. The driver of unit
4 said he saw the driver of unit 2 driving at a high rate of speed coming up behind unit 1. He said unit
2 swerved into unit 1 and caused unit 1 to hit unit 3. Unit 4 had minor damage to both the front and
rear of his vehicle.
The following is a summary of what Unit 5 said happened. The driver of unit 5 explained that she did
not see much of what happened only that she was hit from behind by unit 4. Unit 5 only had minor
damage to the rear bumper of her vehicle.
Based on the information above, I believe that unit 1 was traveling to fast for the conditions and
couldn't stop in time as traffic slowed. Unit 1 struck unit 2 from behind causing unit 2 to strike unit 3
very hard. Either the Collison itself or momentum from the collision propelled unit 2 forward through
unit 3 which caused unit 2 to crash into the utility pole. Unit 3 then rearended unit 4 and unit 4 did the
same to unit 5.
PAGE 3 OF 7
REPORT NO. ED61924 CASE# 23-4478 OF COLLISION
04/20/23 19:00
OF CbLLI510N
NARRATIVE
Units 1, 2 and 3 were towed by Gene Meyers towing, while units 4 and 5 had minor damage and
where able to drive away from the scene. Because of the various amount of misinformation about the
accident I could not accurately determine an at fault driver, therefor I did not cite anyone.
The driver of unit 2 was later transported to the hospital to be further evaluated for his injuries to his
arm.
This concludes my involvement with this case.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by N. GIRELLO #12607 on 04/20/2023 at 2100 Renton, WA
PAGE 4 OF 7
SUPPLEMENTAL REPORT NO. ED61 924
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-4478
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G
UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY
;TYPE
2 ❑ 1 1 8 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-
5 ❑ AL � PROPERTY � YD ✓ OLDMET PHONE# 3 VEHICLE CYCL PEDESTRIAN OW G
0 1 29
LAST NAME : GHAZNAWI FIRST NAME ABDUL MIDDLE
INITIAL
0 1 30
STREET
NFW AnDRFSP' 12210 SE PETROVITSKY RD CITY RENTON ST WA ZIP 98058
6 [4 1 1 2 31
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs NO✓ zERLOCK YEs❑NO❑✓ YES N ✓
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 12 — 30 — 1975
7 ❑ ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 1 2 32
LICENSE CFHO177 TAr Wq VIN# 1NXBR30E48Z002930
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 TRLR TRLR
VIN.#. VIN.#.
11 0 0 VEH.YEAR2008 MAKE TOYT MODEL COROLL STYLE I VEHICLE TOWED DUET SABLI T�WL5''ERS Gf1VT VFHICIF FROM TO
DAMAGE YES✓NO YES NO ✓
REGISTERED OWNER INFOOWNED BY DRIVER 1 5 33
12 � SHADE IN DAMAGED AREA
� FROM TO
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 963458426 gl"OI'
IN EFFECT &POLICY# 1 5
vEwcLE i 0 BOTTOM 34
4 ❑ ❑ CITATION# CHARGE
13 LEGALLY YES NO
STANDING ❑ ❑ 7
14 UNIT# 4 MOTOR D ❑ PDESTRIAN RTY ❑ DAMAGE THRESHOLD MET PHONE ❑ 35
HC CYCE OWNER YES
LEHAL ABHI MIDDLE' S
❑ 36
15
LAST NAME FIRST NAME INITIAL
2 STREET
16 ❑ ❑ 22443 134TH PL SE CITY KENT ST WA ZIP 98042
NFn+AnnRFss
CDL IGNITION REOUIREE7 IGNITION PRESENT MEDICAL TANSPORTED
17 ❑ INTERLOCK YEs NO✓ INTERLOCK YEs NO✓ rEs NO;./ ❑
DRIVER'S D.O.B 4 37
LICENSE# STATE WA SEX M MMDO YY 01 — 03 — 2001
18 ❑
ON DUTY❑ STATUS' AIRBAG 2 RESTR, 4 EJECT 1 1 HELMET 2 INJURY I 1 NATURE OF INJURIES 38
USE CLASS
19 ❑ CENSE ❑
PLATE# BVN4026 TAr Wq vIN# JTHCFI D26F5024911 3 39
20 ❑ TRAILER' STATE TRAILER ST 3❑ 40
PLATE#< PLATE# ATE
21 ❑ ❑ 41
TRLR TRLR
ViN# YIN#i
42
22 VEH.YEAR MAKEMAKE LEXS MODEL IS STYLE VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE 1
DAMAGE YES NO ✓ YES NO ✓
23 ❑ REGISTERED OWNER INFO OWNED BYDRIVER SHADE IN DAMAGED AREA 43
z s
LIABILITY INSURANCE INSURANCE CO SAFECO H2512545 9'1'OP
❑ IN EFFECT &POLICY# 44
VEHICLE
24 LE ALE YES[:] NO❑ CITATION# CHARGE i06OTiOtvi
LEGALLY
E:l
STANDING 8 7
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
NOAH GIRELLO 04-21-23 02:38 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 OI BADGE 12607 O#I',WA0171300 SCOTT 512012023 PAGE OF❑
3000-345-013(R 11118)
SUPPLEMENTAL REPORT NO. ED61 924
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-4478
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-
5 ❑ AL � PROPERTY � YD OLDMET PHONE# 5 VEHICLE CYCL PEDESTRIAN OW G
� 1 29
LAST NAME MABRY FIRST NAME JACQUELINE MIDDLE' M
INITIAL
STREET 30
NEW AnoRFsP- 20911 72ND AVE W,APT A CITY EDMONDS ST WA ZIP 98026
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs No NTERLOCK YES❑N0fZ I YEs N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv 08 - 09 - 1948
7
ON DUTY� STATUS AIRBAG' 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE BLS0633 [TAT WA VIN# 3KPFN4A8XJE166087
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN It VIN.#.
11 0 0 VEH.YEAR2018 MAKE KIA MODELFORTE STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1I' P FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNED BY DRIVER 1 5 33
12 � SHADE IN DAMAGED AREA
7 j FROM TO
LIABILITY INSURANCE INSURANCE CO SAFECOX5823190 q"i"Olx
IN EFFECT &POLICY# 1
VEHICLE 34
13 4 ecnuv YES❑ NO❑ CITATION# CHARGE 0 BOTTUM
STANDING S} 7
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 Aa "[-] CITY ST ZIP
CDL IGNITION REQUIRED IGNITtGN PRESENT MEDICALTANSPORTED
NTERLOCK YES No NTERLOCK YEs NO YEs NO ❑
17 4 37
LICENSE# STATE SEX MMDDDYBYY
18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38
USE CLASS
19 ❑ LICENSE TAr VIN# 39
PLATE#
20 ❑ TRAILER' TRAILER El40
PLATE#< STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWED 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 LEHIcLE 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.
NOAH GIRELLO 04-21-23 02:38 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 12607 O#I',WA0171300 SCOTT 512012023 PAGE F OF 7
3000-345-013(R 11118)
REPORT NO. ED61924 CASE# ' 23-4478 DATE AND TIME 04/20/23 19:00
OF COLLISION
SL 792�T
76 Gas Stakion
0
m
n
to
UnEI"2 ends m
lading point
PAGE 7 OF 7