HomeMy WebLinkAbout24-129 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# 24-129 2 576
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3❑
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 01 - 1-- 2024 1725 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 4500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET ❑ S ❑ VV❑ BREMERTON AVE NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:3605510038 0 11
30
6� LAST NAME WATERS FIRSTNAME GRACE MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 16627 SE 134TH ST CITY RENTON ST WA 21p 980596923 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 2❑
USE CLASS PRECAUTIONARY EVALUATION ❑
3
10 9❑ LI ENSE BYR9882 STATE WA VIN#' 3VWC57BU6KM187328
ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 7 $ 34
13 2 2019 YOLK JETTA SD DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4
14 2 LIABILI INSURANCE NSURANCE CO FARMERS INSURANCE G761702239
IN EFFECT &POLICY# TOPVEH" CHARGE <1�3
OTTOM 5 36
LEGALLv YES❑NO❑ CITATION# 4A0071516 4AO071516, INATTENTIVE DRIVING,FL RENEW 5
15❑ STANDING 6
MOTOR PEDAL-: PEDESTRIAN : PROPERTY DAM NO
OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER [:]FA.
YES 1/ No D:7343413884
16 a
LAST NAME LEDBETTER FIRST NAME NICOLE MIDDLE IM
INITIAL
17 STREET❑ NEW ADOREss❑' 2659 21ST ST CITY WYANDOTTE ST' MI ZIP 48192 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs❑NOF YEs❑NOF,/
19[—] DRIVER'S STATE MI ]SEX IF D.C.B. 12 _ 11 1979 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES ❑ 40
USE CLASS NECK PAIN
❑ILICENSE 21❑ PLA E# 9GPD091 TATE 41
CA vIN# 7MMVABCM1PN148281 1
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE MAZp MODEL CX-5 STYLE SV I VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO SIXT RENTA CAR 1501 NW 49TH ST SUITE 100 FORT LAUDERDALE FL 33309 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 953267789IN 1 9TOP
'E""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 77P�
26MATTHEW NUGENT 11498 1300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE39523
COLLISION REPORT III III III III III 111
1591972 CASE# 24-129
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'
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.
MATTHEW NUGENT 01-10-24 01:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 1/1112024 2:03:13 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 5:29 Pry TIME POLICE ARRIVED 5:45 PM
PART I PAGE IT]OF 4]
REPORT NO. EE39523 CASE# 24-129 OF COLLISION
01/04/24 17:25
OF CbLLI510N
NARRATIVE
24-129
On 01/04/2024 at approximately 1729 hours, I was dispatched to a blocking vehicle collision at the
intersection of NE 4th Street and the Bremerton Ave NE, within the City Limits of Renton, County of
King, State of Washington.
Upon arrival, I contacted the involved parties and confirmed there was airbag deployment on one of
the involved vehicles as well as a complaint of neck pain from the driver of Unit#2. The driver of Unit
#1 also requested a medical evaluation at the request of their parent who was on scene. Renton
Regional Fire Authority (RRFA) was requested and later responded and treated all involved parties at
the scene. While on scene and with the assistance of other Officers, I collected the involved parties
driving documents and their independent recollection of events leading up to the collision.
The driver of Unit#1 said she was the sole occupant of her vehicle and was traveling eastbound on
NE 4th ST just east of the intersection of Bremerton Ave NE in lane 1 of 2. The driver of Unit#1
stated she was traveling directly behind Unit#2 and saw as Unit#2 was stopped or slowing for traffic.
The driver of Unit#1 stated that she was not paying close enough attention to the roadway and
attempted to stop the vehicle in time but was unable to and subsequently collided with the rear of Unit
#2 causing significant damage to the front of Unit#1.
The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling eastbound
on NE 4th ST just east of the intersection of Bremerton Ave NE in lane 1 of 2. The driver of Unit#2
stated she was stopped for queued traffic stopped at a red light at the controlled intersection ahead.
While Unit#2 was stopped for the traffic signal, Unit#1 collided with the rear of Unit#2 causing
significant damage.
Based on the above statements, 1 determined that the Driver of Unit#1 (Waters) was the predominant
factor for the collision due to inattention causing a collision. Waters should have been paying closer
attention to the movement of traffic in front of her. Upon a DOL records check, Unit#1's vehicle
registration was listed as expired as of 05/14/2022.
1 cited Waters via mail for Inattention causing a collision and expired registration greater than two
months.
Both involved vehicles were impounded due to extensive damage. An exchange of information was
provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 1/10/2024 1:12 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EE39523 CASE# 24-129 DATE AND TIME 01/04/2417:25
OF COLLISION
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PAGE 4 OF 4