HomeMy WebLinkAbout23-2629 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-2629 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 03 - 1-- 2023 1101 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON DR S BLOCK NO. e✓ 3500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BENSON RD S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4256358359 0 7 30
6� LAST NAME SMITH FIRSTNAME TREBUS MIDDLE A 1 0 1 31
INITIAL
STREET ❑ 14504 NE 65TH ST CITy REDMOND ST WA 2jp, 980524632 z
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 3 RESTR 4 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aTES� AYU0852 sTArI WAurN# JN1CA21D8XT220876
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 9 34
13 $ 1999 NISS MAXIMA 4D DAMAGE vEs ONO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO ALANASMITH 14504 NE 65TH ST REDMOND WA 98052 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 INSURANCE CO 3 4
14 ABILI V INSURANCE PROGRESSIVE 928698382
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE to BOTTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ No D:4254431041
16 a
LAST NAME SMITH FIRST NAME ALANA MIDDLE N
INITIAL
17 STREET NEW ADDREs7 14504 NE 65TH ST CITY REDMOND ST WA ZIP 980524632 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[—] D IVEW #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BYG5017 TArE 41
WA VIN# 1J4GZ58SOSC735600 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR 'RLR
UIN#. IN#.
VEH YEAR 1995 MAKE JEEP MODEL GRAND STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO BANKERS YES NO
REGISTERED OWNER INFO ALANA SMITH 14504 NE 65TH ST REDMOND WA 980524632 D:4254431041 VEHICLE NO.2
SHADEDAMAGEbAREA
s Cd
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 928698382IN STOP
'E""LE CITATION# CHARGE to BOTTOM
LEGALLY YES N�
25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
M.MAZURE 11700 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED39622
COLLISION REPORT III III III III III 111
1591972 CASE# 23-2629
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HAMADA-G/LMORE ROBYN J
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
1300 EAGLE RIDGE DR S#A2001 RENTON WA 98055 2138411271 SEXi F MMDOYyry 04 - 15 - 1970
PASSENGER Z POS. USE CLASS WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
NAME
'(LP,STr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# DOE!
SEX MMDDYVYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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.MAZURE 03-04-23 12:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 31512023 3:31:41 PM
BADGE OR ID# 11700 OR]# WA0171300 TIME POLICE DISPATCHED 11:03 AM TIME POLICE ARRIVED',11:06 AM
PART I PAGE IT]OF 5�
REPORT NO. ED39622 CASE# 23-2629 OF COLLISION
03/04/23 11:01
OF CbLLI510N
NARRATIVE
23-2629 RTF
On 3/04/2023 at approximately 1103 hours, I was dispatched to a blocking collision. The collision
occurred at the intersection of Benson Dr S and Benson Rd S, in the City of Renton, County of King,
WA. Dispatch said 3 motor vehicle collision, blocking, and no injuries.
I arrived on scene at approximately 1106 hours to the above location. When I arrived, I observed
three vehicles that were involved in the collision. The first vehicle, unit 1, was a gray 1999 Nissan
Maxima bearing WALP AYU0852 and was driven by Trebus A. Smith. The second vehicle, unit 2,
was a red 1995 Jeep Grand Cherokee bearing WALP BYG5017 and was driven by Alana N.Smith.
The third vehicle, unit 3, was a white 2001 Geo Prizm bearing WALP AXL6456 and was driven by
Kenneth W. Chin. There was also an independent witness to this collision, Robyn J. Hamada-
Gilmore. All parties involved where positively identified by their picture matching DOL photos.
I first talked to Robyn and she told me the following. She was sitting in her car at the intersection
waiting to turn south onto Benson Dr S from Benson Rd S. An ambulance, with their emergency
lights and sirens activated where also getting ready to turn onto southbound Benson Dr S from
Benson Rd S. The ambulance was waiting in the intersection waiting for the traffic to stop. Kenneth's
car was stopped, waiting to continue southbound on Benson Dr S. Alana's car was stopped directly
behind Kenneth. Trebus's car then slammed into the back of Alana causing her car to hit the back of
Kenneth's car. Everyone involved said the same thing.
I then talked to Trebus and he said he saw the cars stopped and also saw the ambulance. But when
he went to hit his brakes, they did not work, and he hit the back of Alana's car. It did appear, based
on the damage, that he did try to serve out of the way.
Renton Fire was on scene and attended to everyone that said they were injured. No one wanted to
go to the hospital.
Both Trebus's and Alana's cars was towed from the scene by Bankers Towing.
I provided all drivers a copy of the exchange of information.
This ends my involvement.
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. ED39622
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-2629
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
D:2067623607
OF 7 29
LAST NAME CHIN FIRST NAME KENNETH MIDDLE'. W
INITIAL
STREET r:i 30
NEW AnDRFSP' 1719 S FERDINAND ST CITY SEATTLE ST WA ZIP 981081959
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs NO NTERLOCK YES❑N0� YEs N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv 03 - 23 - 1963
7
ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE AXL6456 TAr WA VIN# 1y1SK52851Z435656
PLATE#
9 TRAILER TRAILER
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN It VIN.#.
11 0 0 VEH.YEAR2001 MAKE CHEV I MODEL GEO STYLE VEHICLE TOVVE E T SABLIN TOWED BY anvi vFH1I' P FROM TO
DAMAGE YES 'E YES NO
[:::�] REGISTERED OWNER INFOKLYDE CHIN 1719 S FERDINAND ST SEATTLE WA 98108 1 9 33
SHADE IN DAMAGED AREA
12 z 3
FROM TO
LIABILITY INSURANCE INSURANCE CO STATE FARM 2329006-E25.47J q"i"Olx
IN EFFECT &POLICY# 1
EHICLE 34
13 3 LEGALLY YESZ NO❑ CITATION# CHARGE 0 BOTTUM
STANDING } 7
14 ❑ UNIT Tr Vd IRE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE 35
PEDESTRIAN
15 LAST NAME FIRST NAME MIDDLE INITIAL
TIAL
❑
ET
16 STRETRE "F ' CITY ST ZIP
NEW CDL IGNITION REdUiRED 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 TO DUET SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO_ SHADE IN DAMAGED 3 4 4 AREA F 43
z
LIABILITY INSURANCE INSURANCE CO '
VINE
EFFECT &POLICY# i 970P - 4 E:l
44
24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM
LECAtty
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.
M,MAZURE 03-04-23 12:41 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
APPROVED BY DATE
26 ORID# 11700 O#IL WA0171300 KORDEL 3/5/2023 PAGE F41 OFF
3000-345-013(R 11118)
REPORT NO. ED39622 CASE# ' 23-2629 DATE AND TIME 03/04/23 11:01
OF COLLISION
Notto acsl..
4�
PAGE 5 OF 5