HomeMy WebLinkAbout23-9377 ITFF' "POLCERA II I !�� I III I III I IIII III II I . B 27c
COLLISION REP FIT 1591971
CASE 23-9377 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 08 - 1-- 2023 1845 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 ❑ FEET e S ❑ W e 140THWAYSE
❑
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064300767 0 4 30
6❑ LAST NAME RUDOLPH FIRSTNAME IAN MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 20912 MAXWELL RD SE CITY MAPLE VALLEY ST WA 2jp, 98038 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 04 1- O6 - 1991 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aTES� CEP6723 sTArI WAVIN# 2HKRL1864YH560020
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 5 7 34
13 4 2000 HOND ODYSSE VN DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� LIABILI VINSURANCE� INSURANCE CO STATE FARM 472733V01 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE 5 36
E�ALLY YES No CITATION# 3A0381065 CHARGE FAIL TO OBEY TRAFFIC CONTROL o Borrom
15❑ STANDING 8 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
�U-NIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES,/ NO RO 2069928954
16 a
LAST NAME NGUYEN 77771 FIRST NAME DOMINIQUE MIDDLE H
INITIAL
17 STREET NEW ADOREss❑' 516 HARRINGTON AVE NE CITY RENTON ST WA ZIP 98056 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NoF,/
19[—] LICENSE# STATE WA SEX M M D.C.B. 04 26 _ 2001 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 6 NATURE of INJURIES ❑ 40
USE CLASS HAND INJURY
❑21❑ PLATE# BEE7671 TArE WA VIN# 41
JH4CU2F618C003403 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH /a YEAR 2011 MAKE C(fR MODEL 7'$X STYLE $D DAMAGE TO TOWED II OV H 44
Yr
✓WED NOO BLIN GENE MEYERS YES No
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILYA103491393 STOP 5
IN EFFECT
VE—LE ❑ ,J� CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N J
' a
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED90219
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9377
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.
BRYAN GROZAV 08-16-23 01:57 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 811712023 3:26:21 PM
BADGE OR ID# 12489 OR]#' WA0171300 TIME POLICE DISPATCHED 6:47 PM TIME POLICE ARRIVED',6:51 PM
PART I PAGE IT]OF 4�
REPORT NO. ED90219 CASE# 23-9377 OF COLLISION
08/15/23 18:45
OF CbLLI510N
NARRATIVE
CASE 23-9377
SECTOR CITE 3AO381065
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events.
On Thursday August 10th, 2023, at approximately 18:47, 1 responded to a 911 call regarding a two-
vehicle collision at Maple Valley Hwy and 140th Way Se within the City limits of Renton, King County,
Washington.
'CALL REMARKS: VEH ACC, TBONE, HORN HONKING... AIRBAGS DEPLOYED, LINK INJS.
REPORTING SAME, CONFIRMED NON INJURY. RP IN GRY ACRRA TSX VS GRY HONDA VAN.
GRY 2000 HOND ODYSSEY VS BLK HOND ACCORD, BILKING 1 LANE ON MAPLE VALLEY HWY.
-UNIT ONE: GREEN 2000 HONDA ODYSSEY WASHINGTON LICENSE: CEP6723
-UNIT ONE DRIVER: IAN A. RUDOLPH (DOB: 4.06.1991)
-UNIT TWO: GRAY 2011 ACURA TSX WASHINGTON LICENSE: BEE7671
-UNIT TWO DRIVER: DOMINIQUE H. NGUYEN (DOB: 4.26.2001)
1 arrived on scene and confirmed there were no injuries. Dominique had a minor injury to his right
hand but indicated he did not need medical attention. Both vehicles were partial blocking the lane and
needed to be towed since they were not drivable.
I contacted Ian who reported the following; he was driving east on Maple Valley Hwy and saw the
light was green, so he proceeded through the intersection and crashed into unit two.
Dominique indicated he was stopped at the red light waiting to take a left turn onto Maple Valley Hwy
from 140th Way Se. When the light turned green, he proceeded through the intersection but was
involved in a crash in the intersection.
A witness on scene indicated the crash was caught on his Tesla exterior cameras. Timothy H.
Jenkins (DOB:11.30.2000) pulled up the video of the crash on his Tesla center screen which showed
Ian running the red light crashing into the Dominique who had the green light. Timothy uploaded the
video to evidence.
Based on the circumstances it was determined Ian violated RCW 46.61.050 FAIL TO OBEY
TRAFFIC CONTROL DEVICE. I issued Ian a traffic infraction on scene since he failed to stop at the
red light which caused the crash.
All involved vehicles were provided a copy of the SECTOR exchange of information form.
This concludes my involvement in this case.
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 B. Grozav #12489 on 8.16.2023 at 01:53 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED90219 CASE# ' 23-9377 DATE AND TIME 08/15/23 18:45
OF COLLISION
L—Iff.Id
NOT TO SCALE
140 WAY 5E
NtAPLE VALLEY HWY
PAGE 4 OF 4