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Home My WebLink About23-14833 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 3 27c COLLISION REP FIT 1591971 ❑ ❑ FIRE ❑ CASE$# 23-14833 2 571 INTERSTATE CITY STREET RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 28 TRIBAL UNITS 01 STRUCK' UT/LITYPOLE RESERVATION 2 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ C{YLLISION 1Q - 1-— 2023 1700 17 ❑.= S 8 W IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BENSON RD S BLOCK NO. e✓ 2000 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 1501. 00 FEET MILES e S B W e S PUGET DR 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ✓NO D:4252771749 30 6� LAST NAME SCHAFFER FIRSTNAME GENE MIDDLE B 1 1 2 31 INITIAL STREET El 11435 SE 162ND ST CITY RENTON ST WA Zlp' 98055 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/iNTERLOCKYEs NO INTERLOCKYEs Z/NO YES 1/ NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 2❑ USE CLASS DIABETIC ISSUE,HEAD TRAUMA 3 10❑ Pl QTNFS# AHH2O68 STATE WA VIN#' 1 FMZU74W24UA84254 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM TO rRLRRLR 1 5 33 12❑ VIN#' VIN# 2004 FORD EXPLOR UTYES[:] ❑ FROM 34 ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13 $ DAMAGE YES NO �/ YES NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4 IN EFFECT &POLICy# 912P VEHICLE CHARGE 5 36 LEGALLv YEs❑NO❑ CITATION# 10 BOTTOM 15❑ STANDING 6 UNIT o2 MOTOVEHIR ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER YES ❑ DYES NO OLD MET PHONE 16❑ LAST NAME FIRST NAME MIDDLE INITIAL STREET CITY' ST ZIP 37 17❑ NEW ADDRESS❑' 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38 INTERLOCK YES❑NOR INTERLOCK YEs❑NOF YES❑NO❑ 19 LLIRIVEWSTICENS # 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 I 9TOP 5 VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM LEGALLY YES N J 25 s e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 E.EDMUNDS 12576 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE60272 COLLISION REPORT III III III III III 111 1591972 CASE# 23-14833 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. E.EDMUNDS 01-01-24 01:47AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 311912024 12:39:10 AM BADGE OR ID# 12576 ORI# WA0171300 TIME POLICE DISPATCHED'; 5:03 PM TIME POLICE ARRIVED',5:04 PM PART I PAGE IT]OF 4� REPORT NO. EE60272 CASE# 23-14833 OF COLLISION 12/26/23 17:00 OF CbLLI510N NARRATIVE On 12/26/2023 1 was working a marked patrol unit in the City of Renton, County of King, State of Washington. I was assigned to District 14. At approximately 1704 hours, I was dispatched to an unknown injury collision in the 2000 block of Benson RD S (Renton WA, King County). Call notes stated: "AT GAS STATION ACROSS STREET.. MVA VS TELEPHONE POLE.. UNK INJURIES.. NON BLOCKING...ALL OF POWER IS OUT IN THE AREA.. UNK FURTHER.. RP SAYS IT IS TOO DARK TO PROVIDE FURTHER DETAILS...NE VEH INTO POLE, DRIVER GETTING OUT, TRANSFORMER BLEW, LIGHTS OUT AT NABORING BUSNS, NO WIRES DOWN..." Actions: I responded to the intersection and observed a vehicle (WA/AHH2O68) stopped, facing southbound, on the shoulder where it collided with an electrical pole. A single line was down from the pole, contacting the street. No other vehicles or structures appeared to be involved. A group of people were assisting an elderly male (later identified as Gene Bradley Shaffer- 01/15/1952). 1 instructed the group to move away from the wires and they assisted Shaffer to his feet, guiding him down a slope to lean against a nearby vehicle. The vehicle had stopped at the point it impacted the pole. I observed air bag deployment, front end, and front windshield damage. Damage was clearly above $1000. 1 requested fire respond to the scene to evaluate Shaffer and determine if the downed line was hazardous. I contacted the Shaffer while we waited for fire to arrive. Shaffer was unsteady on his feet and appeared to be confused. Shaffer stated he did not know how the accident happened and was initially unsure where he was coming from. Shaffer eventually replied that he had been at a Mexican food restaurant near Safeway in downtown Renton, however he could not remember the name. Shaffer stated he had margaritas at the restaurant, however he could not remember if he ate food or not. Fire arrived on scene and began a medical evaluation of Shaffer. A blood sugar check was performed which returned significantly higher than normal. Shaffer stated he was diabetic; however, he was unclear if he took medication or not. Shaffer's inability to remember events in the short or long term was concerning. I asked Shaffer if he had any relatives nearby who could assist in handling the issue of his damaged vehicle. Shaffer initially stated yes and asked us to call his son "Rich." After looking in his phone, Shaffer stated "Rich" was his brother in Chicago and could not remember his son's name. After several minutes, Shaffer deduced his son's name was "Matt." I spoke with Matt, advising him of the situation and requesting he come to the scene and deal with the vehicle. Shaffer was transported to Valley Medical Center for evaluation and treatment. An NCIC/WACIC check was conducted with Shaffer's information which returned clear. Gene Meyers privately towed Shaffer's vehicle after speaking with Shaffer's son. While completing a traffic collision report, my MCT encountered an error, preventing me from completing a collision diagram. This concluded my involvement with the case. 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 E. Edmunds/12576 at 1904 hours on 12/26/2023 in the City of Renton, WA. PAGE 3 OF 4 REPORT NO. EE60272 CASE# ' 23-14833 DATE AND TIME 12/26/23 17:00 OF COLLISION e, r 'i�� '' ��' C tS Y•1� f' #�� f 1 ay S t 4 t I x Ytt4 1 l MM d e , u, :vb. tyro .i Yr. f F � j i 4 t x }iz PAGE 4 OF 4