HomeMy WebLinkAbout23-10215 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED97752 170
27
COLLISION REP FIT 1591971
CASE 23-10215 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4300 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#
cawsloN 09 - 1-- 2023 0715 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
BENSON DR MILEPOST
4a❑
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 F,/ I D:2067787198 0 11
30
6� LAST NAME ANCHETA FIRSTNAME LYRIC MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 3511 MILL AVE S CITY RENTON ST WA Zlp' 980556806 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LRIIVERS STATE WA SEX'F MM DAY' 08 1- 02 - 2007 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� ALT8636 sTArI WAvIN# 5XYKUDA69DG410321
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 N MAKE KIA MODEL SORENT STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO JOSEPHKLINEFELTER3111MILLAVESRENTONWA98055 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCE CO METRO HOMEAND AUTO 2620701061 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO %/ RO 2532798906
LAST NAME BATINGAN FIRST NAME JONATHAN MIDDLE I B
INITIAL
17❑ STREET ❑', 17735 105TH PL SE APT C103 CITY' RENTON ST WA ZIP 980558403 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
19 D IVEW #
I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 1 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE BTW8897 TAre WA VINIi JTMBFREV6D5026028
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2013 MAKE TOYT MODEL RAV4 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JONATHAN BATINGAN 17735105TH PL SEAPTK103 RENTONWA98055 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 951385996IN STOP 5
V'""LE ❑ Nu,J CITATION# CHARGE io BOTTOM
LEGALLY YES
25 ' e
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. ED97752
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10215
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 090523 1 responded to a 2-vehicle non-injury/non-blocking collision at Benson RD and Benson Dr.
I contacted the driver of unit 2 who told me they were traveling in the #2 lane of Benson Dr,
approaching Benson Rd (on fresh yellow light) when they were involved in a collision with unit 1.
I contacted the driver of unit 1 who told me there were in a left-turn lane of southbound Benson Dr to
eastbound Benson RD (on a fresh yellow arrow) when they were involved in a collision with unit 2.
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 09-05-23 07:58 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 911112023 10:20:55 AM
BADGE OR ID# 10377 ORI#' WA0171300 TIME POLICE DISPATCHED; 7:15 AM TIME POLICE ARRIVED 7:20 AM
PART I PAGE IT]OF 3�
REPORT NO. ED97752 CASE# 23-10215 DATE AND TIME 09/05/23 07:15
OF COLLISION
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