HomeMy WebLinkAbout23-6912 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-6912 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 TOTAL#OF OBJECT 2$
0 5
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# 6 2
cawsloN 06 - 17 - 2023 2233 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR S BLOCK NO. e✓ 17500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:4256791291 30
6� LAST NAME HUANG FIRSTNAME WU MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 2905 SE 3RD CT CITY RENTON ST WA Zlp' 980565817 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BUZ2383 sTArI WAvIN# JTMEWRFV1tJ043076
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12❑ vIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13❑2 2020 TOYT RAV4 DAMAGE YES NO ✓ YES[:] No
✓
REGISTERED OWNER INFO HUI CHEN 2905SE 3RD CT RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO ECONOMY PREFERRED 8322243290 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY
res❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN,DIING 7 6
UNIT U2 VEHICCMOTOLE ❑ CYCLE ❑ PEDESTRIAN ❑✓ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME STEWART FIRST NAME SARA MIDDLE A
INITIAL
17❑ STREET ❑', 16143 126TH AVE SE CITY' RENTON ST WA ZIP 98058 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 LDI IVERI # STATE WA ]SEX IF M .C... 01 28 _ 1990 0 39
20 ON DUTY STATUS 3 AIRBAG RESTR EJECT I HELMET 2 LASSY 7 UNCOOPERATIVE,GENERAL COMPLAINT OF PAIN ❑�NATURE OF INJURIES 40
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 6 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I VEHICLE ❑ ,.I—I CITATION# CHARGE
25 GQ
LEGALLY YES N`LJ
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
K.LANE 10008 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED72243
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6912
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'
Unit 1 was traveling northbound on Benson DR S after accelerating from a stop traveling at a speed
Driver 1 estimated at around 20mph. Pedestrian was crossing west to east over Benson DR S just
north of SE Carr RD, outside of any crosswalk, and not in an area of the roadway designed for
pedestrian traffic. Pedestrian was running or at a quick jog and ran out into the path of Unit 1.
Pedestrian collided with the front driver's side corner of Unit 1 causing damage to Unit 1. Pedestrian
sustained unknown injuries as she was uncooperative in providing information and stated just that
she was in pain.
Just prior to the collision, the pedestrian had been in a parking lot of an adjacent business knocking
over carts and yelling. Officers attempted contact but she refused any assistance and left the area
which lead to her running across the street. It appeared as though she was suffering from some sort
of mental health crisis or suffering the effects of narcotics use which led to her erratic and
unpredictable behavior. See full case report for further information regarding this.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 06-18-23 02:02 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/21/2023 10:39:11 AM
BADGE OR ID# 10008 ORI# WA0171300 TIME POLICE DISPATCHED; 10:35 PM TIME POLICE ARRIVED',10:36 PM
PART I PAGE IT]OF 3�
REPORT NO. ED72243 CASE# 23-6912 DATE AND TIME 06/17/23 22:33
OF COLLISION
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