HomeMy WebLinkAbout23-5088 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-5088 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 04 STRUCK NONE
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 05 - 1-- 2023 1508 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LOGAN AVE N BLOCK NO. e✓ 400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e N 3RD ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2533942089 0 7 30
6� LAST NAME BENAVIDEZ FIRSTNAME DAVID MIDDLE J 1 2 31
INITIAL
ADORE STREET ❑ 7205 183RD AVE E CITY BONNEY LAKE ST WA 2jp, 983918539 z=
'NEW SS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H U EET 2 CLASS 1 NATURE OF INJURIES z❑
3
,OF
P1 ATNES# 21973P sTATe ND V N# 3AKBCYBS4DDFF4417
TRAILER T175544 STATE ND TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR 5 1. TRLR 33
12 3 5 VIN If vIN#
VI FROM TO
❑ VEH.YEAR 2013 FRHT M2 106 SE MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
DAMAGE YES NO
13 4 YES[:] No
REGISTERED OWNER INFO MIDWEST EXPRESS INC PO BOX 1058 BISMARCK NO 585021058 D:2062483879 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EF IT INSURANCE UNITED STATES FIRE INSURANCE COMPANY 603.102592.8
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 El
36
E'ALLY res No CITATION# 3A0346434 FOLLOW VEHICLE TOO CLOSELY o eorrom
15❑ STANDING 7 6
MOTOR PEDAL- ❑ ..PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:4256223445
16 2
LAST NAME BILLINGS FIRST NAME KYLE MIDDLE /
INITIAL
17❑ STREET
NEW ADDRES ' 3607 120TH PL SE CITY' EVERETT ST WA ZIP 982085628 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALt-T�RANSPORTED 38
INTERLOCK ES❑No� INTERLOCK YEs I I NoF YEs t l NOz
19 LDIIVE STATE WA SEX M MMDDYY O6 _ 25 _ 1985 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# BIS9713 TATE WA VIN# 41
JF2GTADC7J8272162 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2018 MAKE SUBA MODEL CROSST STYLE 5D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO KYLE BILLINGS 1009112TH ST SE UNIT D204 EVERETT WA 98208 D:4256223445 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE 8 POLICY#E CO GEICO 6129859762IN I 9TOP
VEHICLE CITATION# CHARGE
25❑ i o BOTTOM
LEGALLY YES N(�
J
s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
BENJAMIN FLICK 12825 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED59006
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5088
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.
BENJAMIN FLICK 05-05-23 06:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 5/10/2023 4:01:51 PM
BADGE OR ID# 12825 ORI# WA0171300 TIME POLICE DISPATCHED 3:11 PM TIME POLICE ARRIVED]3:13 PM
PART I PAGE IT]OF
REPORT NO. ED59006 CASE# 23-5088 OF COLLISION
05/05/23 15:08
OF CbLLI510N
NARRATIVE
23-5088
On 05-05-2023 at approximately 1508 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, Washington. I responded to a motor vehicle collision at the
cross of N 3rd ST and Logan AVE N.
Upon arrival I made contact with all 4 vehicles involved. All 4 involved drivers agreed upon the
circumstances that occurred. The involved units and drivers were identified as follows:
Unit 1 (ND/21973P) driver David J. Benavidez (DOB: 10-28-1959 via WADOL)
Unit 2 (WA/BIS9713) driver Kyle J. Billings (DOB: 06-25-1985 via WADOL)
Unit 3 (WA/BNY9160) Mustapha Achir (DOB: 02-26-1968 via WADOL)
Unit 4 (WA/BCG1111) Kimberly L. Coyle (DOB: 01-04-1964 via WADOL)
All 4 involved units were northbound on Logan AVE N from N 3rd ST.
Units 2, 3, and 4 were all stopped for traffic on Logan AVE N just north of the intersection of N 3rd ST
as unit 1 proceeded through the green light and then could not stop in time and collided with unit 2,
pushing unit 2 into unit 3, which pushed unit 3 into unit 4.
Driver Achir had head and neck pain as a result of the collision. He was medically evaluated by the
fire department and left at the scene, however, later on he stated that his pain was present and
wanted to be transported to the hospital. I called the fire department back to the scene to evaluate
him again and he was transported to the hospital via ambulance.
I provided all four parties with an exchange of information via Sector which contained the case
number.
I observed that the damage to the vehicles was consistent with what all 4 parties had told me.
At the conclusion of my investigation, I determined that driver Benavidez had been following too
closely as he was not able to stop in time. I confirmed with driver Benavidez that his DOL address
was current. I informed him that he would be receiving a citation for following too closely via mail.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by B. Flick 12825 on 05-05-2023 in Renton, WA.
PAGE 3 OF 5
SUPPLEMENTAL REPORT NO. ED559006
r`) POLICE TRAFFIC 1 1 8 27
COLLISION REPORT CASE# 23-5088
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓ G
UNIT'# 1 USDOT ICC# I VEHICLE TYPE 2 CARGO BODY 9
TYPE
2 ❑ 1El28
CARRIER NAME. MIDWEST MOTOR EXPRESS INC
.....
3 CARRIER
ADDRESS PO BOX 1058
CITY BISMARCK ST NO ZIP 58502
4 ❑ NAME # PLACARD: :❑ ME NA IF NO NUMBER
SOURCE 3 AXLES 03 GI 54000 +
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE ISJ CYCLE I_) PEDESTRIAN OWNER YES NO ✓
D:2066593786
0 7 29
LAST NAME ACHIR FIRST NAME MUSTAPHA MIDDLE N
INITIAL
0 7 STREET 30
NFW Anr)RFg 7811 218TH ST APT#39 CITY EDMONDS ST WA ZIP 98026
6 ❑ 1 1 2 31
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TAN5PORrED
INTERLOCK YEs NO✓ zERLOCK YEs❑NO❑✓ YEs✓ N
DRIVER'S
LICENSE STATE I WA SEX M MMDDYYv', 02 - 26 - 1968
7 ❑ HELMET :INJURY' NATURE OF INJURIES
ON DUTY STATUS AIRBAG 1 RESTR. 4 EJECT 1 USE 2 CLASS 6 NECKAND HEAD PAIN
8 ❑ 1 1 2 32
LICENSE BNY9160 TAT WA VIN# 3N1CP5CU9JL526199
PLATE#
9 TRAILER TRAILER 91 PLATE# STATE PLATE# STATE
10 � TRLR TRLR
VIN.#. VIN.#.
11 3 5 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vEHlci F FROM TO
2O1H NISS KICKS DAMAGE YES NO ✓ YES NO ✓
33
REGISTERED OWNER INFOMUSTAPHA ACHIR 7811218TH ST SW APT 39 EDMONDSWA98026 D:2066593786 J 9
12 3 5 SHADE IN DAMAGED AREA
7 j4 FROM TO
LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYA104114419 <�*
IN EFFECT &POLICY# 9 9
VEHICLE 34
13 4 LEGALLY YESZ NO❑ CITATION# CHARGE
STANDING 8 7 6
DAMAGE THRESHOLD MET PHONE ❑ 35
14 UNIT# 4 MOTOR ❑✓ PEDAL ❑ PEDESTRIAN ❑ PROPERTY ❑ YES NO
VEHICLE : CYCLE OWNER ✓ D:2068902408
15 COYLE KIMBERLY MIAIDDLE L
❑ 36
LAST NAME FIRST NAME INITL I
2 STREET
16 ❑ '❑; 2607 NE 12TH ST CITY', RENTON ST WA ZIP 980563020
N�n+AnnRFss
CDL IGNITION REdUiRED IGNITION PRESENT MEDICAL TANSPORTED
17 ❑ INTERLOCK YEs NO✓ INTERLOCK YES NO✓ YEs NO,/ ❑
DRIVER'S D.O.B 4 37
LICENSE# STATE WA SEX F MMDO' 01 - 04 - 1964
18 ❑
ON DUTY❑ STATUS AIRBAG 2 RESTR, 4 EJECT 1 1 HELMET 2 INJURY 1 NATURE OF INJURIES 38
USE CLASS
19 ❑ LICENSE ❑
LATE# BGC1111 TAr WA vIN# KNAFK4A68G5500335 3 39
20 ❑ TRAILER' TRAILER 40
PLATE# STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# YIN#i
42
22 VEH.YEA MAKEMAKE KIA MODEL FORTE STYLE VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE 1
DAMAGE YES NO �/ YESM NO ✓
23 ❑ REGISTERED OWNER INFOXIMBERLY COYLE 2607 NE 12TH ST RENTON WA 98056 D:2068902408 SHADE IN DAMAGED AREA 43
4
71
LIABILITY INSURANCE INSURANCE CO FARMERS INSURANCE 188050311 9'1'OP
❑ VEHICLE
EFFECT &POLICY# i _'.''_ 44
24 LE
E ALE YESZ NO❑ CITATION# CHARGE iq 6OTiOM
LEGALLY
E:l
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.
BENJAMIN FLICK 05-05-23 06:42 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 OI BADGE 12825 O#II,WA0171300 APPROVED BY
511012023 PAGE F OF❑
3000-345-013(R 11118)
REPORT NO. ED59006 CASE# ' 23-5088 DATE AND TIME 05/05/23 15:08
OF COLLISION
N
Unit 4--_-_� E
Unit 3 ,
G
Unit 2 '
Not to scale
�4
Unit 1_ N 3rd ST
a `
Parking Lot
PAGE 5 OF 5