HomeMy WebLinkAbout23-7472 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7472 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 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# ❑
COLLISION: 07 — 1—— 2023 0843 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON DR S BLOCK NO. e✓ 17300
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:2067781322 0 4 30
6� LAST NAME MAHAT FIRSTNAME ASHA MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 12731 SE 173RD PL CITy RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CBY3317 sTAr� WAVIN# 4T3MWRFVOMU032309
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR 4 8 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 2 4 34
13 2 2021 TOYT RAV4 UT DAMAGE vE6 ONO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO 2A..JARATO 12731 SE 173RD PL RENTONWA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI V INSURANCE INSURANCE CO STATE FARM 523 6483-C12.47A 3 4
IN EFFECT &POLICY# 9TOP
15❑ vECEHA"LE 5 36
LLLv res❑NO❑ CITATION# 3A0509881 CHARGE FAIL STOP AT STOP 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- ❑ PEDESTRIAN ❑ PROPERTY DAM THR PHONE
UNIT 02 VEHICLE ❑ CYCLE OWNER ❑ YES 1/ NO OLD MET D:2069202895
16 a
LAST NAME STRUCK FIRST NAME PATRICIA MIDDLE E
INITIAL
17 NEW STREETR 11307 S
7 E 217TH ST CITY KENT ST WA ZIP 98031 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK vEs❑NOF YEs❑NOF,/
19 D IVERI #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# AYA1251 TArE 41
WA VIN# JTDKN3DUOF1998520 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED By Gov HI 44
VEH YEAR 2015 MAKE 7'Dy7- MODEL pRIUS STYLE 3P —FEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO SAFECO H876290IN 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED78060
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7472
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MUHAT MURAT
(LAST FIRST,
ADDRESS&PHONE#
12731 SE 173RD PL RENTON WA 98058 SEX M MMDOYyry - -
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS� UNIT# 1 POS. 7 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 6 CUT TO LIP
NAME
(LAST,FIRST,MIDDLE INITIAL) MAHAT SALADO
ADDRESS&PHONE# DOB -
12731 SE 173RD PL RENTON WA 98058 SEX M MMaDYVYv
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 1 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
STEVEN FAJARlLLO 07-02-23 02:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 711012023 4:44:52 AM
BADGE OR ID# 12847 ORI# WA0171300 TIME POLICE DISPATCHED 8:56 AM TIME POLICE ARRIVED:9:00 AM
PART I PAGE IT]OF 4]
REPORT NO. ED78060 CASE# 23-7472 OF COLLISION
07/02/23 08:43
OF CbLLI510N
NARRATIVE
On 07-02-2023 1 was working as a police officer in the city of Renton. At approximately 0856 hours I
was dispatched to the report of a blocking collision at the intersection of Benson Dr S/174th St SE,
City of Renton, County of King, WA. This incident was captured on my department issued body
camera and my vehicles Axon camera system.
I arrived on scene and the collsion occurred at the intersection of Benson Dr S/ Benson Rd S. I
contacted both parties and confirmed they were uninjured. One of the passengers had a small cut on
his lip and was evaluated by Renton Regional Fire authority.
The driver of Vehicle 1 advised she was driving northwest on Benson Dr S through the intersection.
As she was approaching the intersection she went to press on the brake, but her clothes got caught
and incidentally pressed the gas.
The driver of Vehicle 2 was stopped at the intersection on Benson Rd S. When the light turned green
she took a left towards Benson Dr S. She said she saw Vehicle 1 approaching, but was unable to
brake in time to prevent a collision.
Both drivers were provided a case number. Both vehicles were towed by Bankers Towing.
The driver of Vehicle 1 failed to yield to the right of way at the stop light; therefore colliding with
Vehicle 2. 1 mailed the driver of Vehicle 1 a notice of infraction based on the aforementioned violation.
Nothing further.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Fajarillo #12847 on 07/02/2023 @ 1415 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. ED7 0 O CASE# 2y7 7 AT m°M\ O»0/230 a3
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