HomeMy WebLinkAbout24-2283 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 24-2283 2 0 7
INTERSTATE CITY STREET ✓ RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3❑HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 03 STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 03 - 01 - 2024 1518 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
SE CARR RD MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 103RD AVE SE
0 1 29
UNIT MOTOORVECL Z CYCLE ElDDAMYESA✓NOESHOLD MET PHONE 0 1 30
6� LAST NAME ZHENG FIRSTNAME XIAOHONG MIDDLE N 1 9 2 31
INITIAL
STREET ❑ 26215 SE 33RD ST CITY SAMMAMISH ST WA ZIP 980759129 2=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVERS STATE WA SEX'M MM DAY' 03 1- 10 - 1966 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES 2❑
3
,OF
P1 ATE B 4 AZD0890 JBTATIJ WAV N# WDDHF8JBOG6181895
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
rRLR TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T/yj�)��p/ggY GOVT.VEHICLE 3 7 34
13 2 2016 MERZ E DAMAGE YES NO �"-"--"TE YES❑ NO✓
REGISTERED OWNER INFO XIAOHONG ZHENG 21215 SE 33RD ST SAMMAMISH WA 98075 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
❑ ❑ INSURANCE CO 3 4
14 INLIABILITYEFFECT INSURANCE ✓ SAME.
IN EFFECT &POLICY# 9TOP
vE— CHARGE 1 o BOTTOM 36
EGALLv YES No CITATION# 4AO078049 NEGLIGENT DRIVING 2ND DEGREE
15❑ STAIN.D'ING 8 7 6
UNIT a2 VEHICMOTOLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME TRAN FIRST NAME THUY MIDDLE K
INITIAL
17❑ STREET ❑', 9601 S 248TH ST CITY KENT ST WA ZIP 980304863 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l No❑
19 DRIVER'S STATE WA ]SEX IF D.Q.B. 02 _ 28 _ 1983 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CJN4167 TAre WA VINIi 5TDKDRBHOPS038033
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2028 MAKE TOYT MODEL HIGHLAN STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO VOLAMCO INC 16720 INTERNATIONAL BLVD SEATAC WA 98188 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME I 9TOP
'E""LE ❑ Nu
J
,J� CITATION# CHARGE
LEG i o BOTTOM
AFLY YES
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE57079
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2283
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.
M.LEVERTON 03-06-24 04:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 31712024 5:58:15 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED; 3:44 PM TIME POLICE ARRIVED',3:48 PM
PART I PAGE IT]OF
TIME
REPORT NO. EE57079 CASE# 24-2283 OF COLLISIONO3/01/24 15:18
NARRATIVE
blk sedan rear moving unit 2 wht suv Brat sedan 3 hits 1 from behind
CC
Within the city limits of Renton/King/WA I responded to a 3 car blocking crash at SE Carr Rd at 103rd
Ave SE.
I contacted the driver of unit 2 who told me she was westbound in lane 2 going about 35 mph when
she was rear-ended by unit 1. She said she stopped after she was hit in lane 2 as did unit 1. Unit 2
did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 3 who told me she was behind unit 1 when he ran into the back of unit 2.
They came to a sudden stop and she was unable to avoid contact. She contacted unit 2 from behind.
She did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his matching picture WADL. He was telling the other drivers to
be quiet and calling them liars. I asked him what happened and he told me that unit 2 slowed or
stopped suddenly and he hit her then was rear-ended by unit 3. Both unit 2 and 3 said not what
happened. He did not complain of injury and had a tow truck that he called before I cleared the
scene.
Damage to unit 2 was primarily on the passenger front of his car while the damage to unit 2 was
mostly left/driver side rear. Unit 2 told me she wasnt slowing or stopping she was going 35 mph
when she was hit. The POI was lane 2 in a slight grade curve to the right. It appeared that either unit
1 made a sudden lane change to avoid a car in lane 1 that unit 3 did not notice or unit 1 was traveling
too fast and rear ended a moving car or possibly distracted on his phone. Ref RCW 46.61.525 unit 1
did drive in a manner that did driver both negligently and endanger other persons and property.
I cited unit 1 ref RCW 46.61.525 Negligent Driving 2nd Degree via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 3/6/2024
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. EE557079
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 24-2283
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 DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO
0 1 29
LAST NAME MONTALVO-GOMEZ FIRST NAME MA YA MIDDLE' M
INITIAL
STREET 30
NEW AnDRFSP' 14901 SE 179TH ST CITY RENTON ST WA ZIP 980589071
6
CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31
INTERLOCK YEs No NTERLOCK YES[:]NO[:] YES N
DRIVER'S
LICENSE STATE I WA SEX F MMDDYYv 02 - 09 - 2008
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE A7019822 TAr WA VIN# 1N4AL3APODN410644
PLATE#
9 9] TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.It VIN.#.
11 3 5 VEH.YEAR2013 MAKE NISS I MODELALTIMA STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vEH1Ci P FROM TO
DAMAGE YES 'E YES NO
REGISTERED OWNER INFOSAMATHA GOMEZ 14901 SE 179TH ST RENTON WA 980589071 3 ] 33
12 � SHADE IN DAMAGED AREA
4 FROM TO
((ABILITY INSURANCE INSURANCE CO PROGRESSIVE 95325444 gTOp
IN EFFECT &POLICY#
VEHICLE 10 6QTTUM 34
13 ❑ Lecnuv YES❑ NO❑ CITATION# CHARGE gg�@
STANDING S} l:9 7 6
14 ❑ UNIT Tr Vd 1RE O CYDCLE 1:1OWNER YE
YES AGE NOHRESHOLD MET PHONE ❑ 35
PEDESTRIAN
15 LAST NAME FIRST NAME NIITIA 36
L
❑
STREET"[-]
16 NEW nnR CITY ST ZIP
CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED
NTERLOCK 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# 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 AREA 43
3 4 71
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.
X LEVERTON 03-06-24 04:55 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OI BADGE 2517 O#I',WA0171300 APJOHNSON 3n/2024 PAGE F41 OF F
3000-345-013(R 11118)
REPORT NO. EE57079 CASE# ' 24-2283 DATE AND TIME 03/01/24 15:18
OF COLLISION
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PAGE 5 OF 5