HomeMy WebLinkAbout23-6344 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-6344 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 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 06 - 1-- 2023 2116 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR S BLOCK NO. e✓ 17200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 10 00 FEET MILES e S B W e S 172ND ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4253067329 0 11
30
6� LAST NAME HIRANO FIRSTNAME KHAI MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 15470 141 ST PL SE CITY RENTON ST WA 21p 98058 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 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aTES� BVX9673 sTArI WAurN# JNICV6AROAM461694
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 1 5 34
13 4 2010 INFI G37 SD DAMAGE YES NO �MEYERS YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO CONNECT A104121193 3 4
IN EFFECT &POLICY# 9TOP
VEHICe CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063702582
16 a
LAST NAME CHURCH FIRST NAME ALEXANDER MIDDLE D
INITIAL
17 STREET❑ NEW ADOREss❑' 17109 NE 16TH PL CITY BELLEVUE ST WA ZIP 98008 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVERI # STATE WA SEX M M D.O.B. 12 _ 10 _ 1998 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# A6403508 TArE 41
WA VIN# 4T1BE46K09U344228 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
TOWED BY Gov H 44
VEH YEAR 2009 MAKE 7'Dy7- MODEL CAMRY STYLE $D —FEHICLE
TOWED NOO BLIN N/A YES N.7
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 4739763-B01-47AIN 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 7B-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
MIN FLICK 12825 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED69930
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6344
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,FIRS 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 06-05-23 02:18 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 6/13/2023 7:24:52 PM
BADGE OR ID# 12825 OR]# WA0171300 TIME POLICE DISPATCHED! 9:28 Pry/ TIME POLICE ARRIVED]9:Y9 Pry/
PART I PAGE IT]OF 4�
REPORT NO. ED69930 CASE# 23-6344 OF COLLISION
06/04/23 21:16
OF CbLLI510N
NARRATIVE
23-6344
On 06-04-2023 at approximately 2116 hours I was working a marked Renton Police Department
patrol in full uniform in the city of Renton, County of King, State of Washington. I responded to a non-
injury collision on Benson DR S / SE 172nd ST.
Upon arrival I contacted the involved parties. Unit 1 driver was identified as Khai Akio Hirano (DOB:
03/10/2001, via WA driver license). He told me that he had been proceeding northbound on Benson
Dr Swhen a vehicle in front of him slammed on its brakes unexpectedly, coming nearly to a complete
stop. He told me that he braked hard, but still believed he might hit, so he swerved toward oncoming
traffic, swiping the side of unit 02 which was proceeding sorthbound on Benson DR S. Hirano had
been driving unit 1, a white Infiniti G37 with license WA/BVX9673. The damage to unit 1 was to the
driver side front quarter and the damaged disabled the vehicle.
The vehicle that had slammed on its brakes was GOA. Unknown license plate.
I contacted unit 2 driver Alexander D. Church (DOB 12-10-1998 via WA driver license) who had been
driving a Toyota Camry with license WA/A6403508. Church agreed with the circumstances that
Hirano described. The damage to unit 02 was on the driver side.
Unit 01 was towed by Gene Meyer (non-impound).
I provided both parties with a business card and case number.
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 06-05-2023 at 0159 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED69930 CASE# 23-6344 DATE AND TIME 06/04/23 21:16
OF COLLISION
Unit 02 unit 0
(D
not to scale
0
PAGE 4 OF 4