HomeMy WebLinkAbout23-10264 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-10264 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# ❑
cawsloN 09 - 1-- 2023 1931 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE PETROVITSKY RD BLOCK NO. e✓ 11700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065048132 0 6 30
6� LAST NAME HA YES FIRSTNAME TAYLOR MIDDLE M 1 1 2 31
INITIAL
STREET ❑✓ 17710 151 ST AVE SE APT 7H 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 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BQZ8331 sTArI WAvIN# 19XF62F52EE230236
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TAW/g[ GOVT.VEHICLE 34
13 4 2014 HOND CIVIC SD DAMAG 7 3 E YES NO YES❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE71616394 4
IN EFFECT &POLICY# TOPVE"'CLE CHARGE 36
LEGALLYYES❑NO❑ CITATION# 3A0665251 DRIVE DANGEROUSLY DISTRACTED <1�3
orrom
15❑ STANDING 7 6
MOTOR PEDAL- '.PEDESTRIAN PROPERTY DAM THR OLD M PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ ET NO D.2089643150
16 a
LAST NAME POWERS FIRST NAME KIMBERLY MIDDLE A
INITIAL
17❑ NEW STREETR 7 14219 SE FAIRWOOD BLVD CITY RENTON ST WA ZIP 98058 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVERI # STATE WA ]SEX IF M D.C.B. 11 11 1968 39
—NATURE OF INJURIES
H USE CLASS
NJAURSY SORENESS(UPPER BODY) 3 40
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 2 7 ❑
❑LICENSE I 21❑ PLA E# CGN4613 TAre WA VIN# Y►/4162UM7M2442566 41
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BV Gov HI 44
VEH YEAR 2021 MAKE VDLV MODEL XCQO STYLE UT DAMAGE TO WED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO CONNECT BX11507016IN 1 STOP
VEHICLE ❑ ,.I—I CITATION# CHARGE
25 i o BOTTOM
LEGALLY YES N
$
7BEN
S NAME(PRINT) OFFICER PHONE BADGE OR ID# [AGENCY
26
M/N FLICK 12825 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED98991
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10264
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 09-05-23 09:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 911412023 11:39:31 PM
BADGE OR ID# 12825 OR]# WA0171300 TIME POLICE DISPATCHED; 7:31 PM TIME POLICE ARRIVED',7:36 PM
PART I PAGE IT]OF 4�
REPORT NO. ED98991 CASE# 23-10264 OF COLLISION
09/05/23 19:31
OF CbLLI510N
NARRATIVE
23-10264
On 09-05-2023 at approximately 1931 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 in the
1700 block of SE Petrovitsky RD.
Upon arrival I made contact with the 2 vehicles involved. Both drivers agreed upon the circumstances
that occurred. The involved units and drivers were identified as follows:
Unit 1 (WA/BQZ8331) driver Taylor M. Hayes (DOB: 02-25-1998 via WADOL)
Unit 2 (WA/CGN4613) driver Kimberly A. Powers (DOB: 11-11-1968 via WADOL)
Both involved units were eastbound on SE Petrovitsky RD in the 11700 block.
Unit 02, began to slow for stopping traffic in front of her. Driver Powers stated that she had to stop
hard and was not sure if she would be able to stop in time. There had been an unidentified vehicle
and driver making an illegal left turn into an apartment complex across a double-yellow line. The plate
of that vehicle was unknown. The vehicle is unknown as it left the area. Unit 02 did not collide with it.
Unit 01 driver, Hayes, stated that she was looking for something under her dashboard and when she
looked up, traffic was stopping and she was not able to stop in time. She then rear-ended unit 02.
Driver Powers stated that she had soreness in her upper body, but she refused to see the fire
department when I offered to call them to the scene.
Driver Hayes told me she did not have any injuries.
I provided both parties with a business card which contained the case number.
I observed that the damage to the vehicles was consistent with what both parties had told me.
At the conclusion of my investigation, I determined that driver Hayes had been distracted and was not
able to stop in time as a result. I confirmed with driver Hayes that her DOL address was not current
and she provided the correct address (see Sector info). I informed her that she would be receiving a
citation for inattention 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 09-05-2023 in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED98991 CASE# 23-10264 DATE AND TIME 09/05/23 19:31
OF COLLISION
UnftOl
u
mviiim Not to scale
11700 block SE PETROVITSKY RD
PAGE 4 OF 4