HomeMy WebLinkAbout23-9983 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED97759 170
27
COLLISION REP FIT 1591971
CASE 23-9983 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 08 - 1-- 2023 0735 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON DR BLOCK NO. e✓ 17400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a BENSON RD
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2062491098 0 11
30
6� LAST NAME WILLIAMS FIRSTNAME FAITH MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 1190 UNION AVE NE APT D13 CITY RENTON ST WA 2jp, 980594435 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES 1/ NO
8❑ L IIER # STATE yyq SEX'F I D.MM D Y' 01 — 02 — 1975 1 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 3 RESTR 4 EJECT 1 H USE ET 2 CLASS INJURY6 [NATURE OF LOWER BACKRIEs z❑
3
10[1P1 ATNES# BHV4682 sTAr WAv N# 183CB3HA9AD551657
0 TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 4 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2010 MAKE DODG MODEL CALIBE STYLE
F1VEHICLE TOWED 0 TOO
ffBLIN T,OVWkkRS yOS❑ENIC O✓ 5 1 34
DAMAGE ILJI tSA1Wl6
13 REGISTERED OWNER INFO FAITH WILLIAMS1110UNIONAVENEAPTD13APTRENTONWA980594435 D:2062491098 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 4
IN EFFECT &POLICY# 9TOP
VE—LL CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�U-NIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ No D:2537660306
16 a
LAST NAME KOK FIRST NAME KOK MIDDLE A
INITIAL
17❑ STREET � 10700 SE 260TH#N104 CITY' KENT ST WA ZIP 98030 37
NEW ADDRESS I I I I I I ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 09 _ 24 1969 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CHP3399 TAre WA VIN# JTDKN3DU3D5591491
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TIN# IN RLR
#.UIN#. '
VEH YEAR 2013 MAKE TOYT MODEL PRIUS STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES�/ NO BANKERS YES NO
REGISTERED OWNER INFO KOK KOK 10700 SE 260TH ST UNIT N104 KENT WA 98030 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO PROGRESSIVE 971143197
IN STOP 5
VE""LE ❑ Nu,J CITATION# CHARGE
LEGAL io BOTTOM
LY YES
25 ' 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.M/TCHELL 10377 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED97759
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9983
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'
On 083023 1 responded to a 2-vehicle injury/ blocking collision at Benson Dr and Benson Rd.
I contacted the driver of unit 2 who told me they were traveling northbound in the #1 lane of Benson
Dr (approaching Benson Rd). Driver says he entered the intersection at Benson Rd on a fresh yellow
light and was involved in a collision with unit 1. The driver was not injured. Unit sustained heavy
front-end damage and Bankers Towing was requested
I contacted the driver of unit 1 who told me they were making a left turn from southbound Benson Dr
to eastbound Benson Rd on a fresh yellow light when they were involved in a collision with unit 2. The
driver was treated by Renton Fire due to complaint of lower back pain. She was transported to Valley
Medical for further observation. Bankers Towing was requested due to heavy front-end damage
But not for the action of UNIT 1 DRIVER the result would not have happened.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.MITCHELL 08-30-23 11:23 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 911112023 10:22:05 AM
BADGE OR ID# 10377 ORI# WA0171300 TIME POLICE DISPATCHED! 7:35 AM TIME POLICE ARRIVED 7:40 AM
PART I PAGE IT]OF 3�
REPORT NO. ED97759 CASE# ' 23-9983 DATE AND TIME 08/30/23 07:35
OF COLLISION
BENSON RD
t�
z
0
co
z
w
m
PAGE 3 OF 3