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COLLISION REP FIT 1591971
CASE 23-14511 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 ❑28
TRIBAL UNITS 01 STRUCK STREET LIGHT POLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GawsloN 12 - 18 - 2023 1446 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 26TH ST BLOCK NO. e✓ 1200 ❑
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ VV a BENSON RD S
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:3603169641 30
6li LAST NAME PERSON FIRSTNAME DONALD MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 16803 120TH AVE SE CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LICENSE# STATE Wq SEXI M M -O B 10 - 10 - 1996 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 H U SE 9 1 INJURY CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATE 14 BZU7524 JBTATIJ WAv N# 5YFEPRAEOLP087800
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. TRLR 7 3
2❑ 33
1 VIN#' VIN#
FR.. 34
13❑ VEH.YEAR2020 MAKE TOYT MODEL COROL STYLE SD VEHICLE TOWEDNOOpLSABLIN T� IZRTOWING YOs❑ENo�
HICLE
DAMAGE IILLJJII
REGISTERED OWNER INFO DONALD PERSON 17128 CLEAR LAKE BLVD SE YELM WA 98597 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE INSURANCE CO STATE FARM 4865274B1947B 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STAIN,DIING 6
UNIT 02 VEHICCLE ❑ CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIICENS # STATE SEX MMDDYY -❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE"LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
=TAMAIVENA
AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12812 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE33325
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14511
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PERSON ROWAN S
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
16803 120TH AVE SE RENTON WA 98058 SEX M MMDDYyry 06 - 23 - 2021
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 1 POS. 7 6 11 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYI'YY
PASSENGER ❑WITNESS 0 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 12/18/2023 at approximately 1448 hours, while employed as a uniformed Patrol Officer for the
City of Renton, I viewed a collision with a car and a traffic light pole, located at 1200 S 26th St, within
the City of Renton, County of King, State of Washington.
I viewed a silver 2020 Toyota Corolla with license plate #BZY7524, which crashed into a traffic light
pole. The front bumper was damaged, and I saw smoke coming out from the Corolla. All airbags were
deployed from the Corolla. I saw Donald J Person (DOB 10/10/1996) grabbing his son Rowan S.M
Person from the back driver seat.
Donald stated he fell asleep while he was driving east on S 26th St approaching Benson Rd S. He
woke up from the impact of the Corolla hitting the traffic pole light. Donald said that he was tired from
staying up with his son. He said he only got 3 hours of sleep last night. I did not observe any signs of
intoxication on Donald or the Corolla.
Renton Fire was on scene for this incident and cleared Donald and Rowan with no injuries.
Bankers Towing was on scene for this incident.
I certify (declare) under penalty of perjury under the laws the State of Washington that the foregoing
is true and correct. This report was electronically signed by Officer Si. Tamaivena #12812, December
18, 2023, at 1615 hours Renton, WA.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Location Character: SIDEWALK
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
S/TIVENI TAMAIVENA 12-18-23 04:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 12/22/2023 11:44:35 AM
BADGE OR ID# 1Y892 OR]# WA0171300 TIME POLICE DISPATCHED; 2i48 Pry] TIME POLICE ARRIVED'2:48 PM
PART I PAGE IT]OF 3�
REPORT NO. EE33325 CASE# ' 23-14511 DATE AND TIME 12/18/23 14:46
OF COLLISION
t
�zS
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