HomeMy WebLinkAbout23-12722 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12722 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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 RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 11 - 1-- 2023 1609 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR S BLOCK NO. e✓ 17300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e S 174TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2066832385 0 7 30
6� LAST NAME CARLONE FIRSTNAME IAN MIDDLE D 1 1 2 31
INITIAL
STREET ❑, 4333 EAGLE LANDING PKWY CITY ORANGE PARK ST FL ZIP 32065 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 H U EET 2 CLASSy 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 ATE 14 22740$3 STATE CA VN# 1 C6SRFJT2PN540397
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 3 2023 DODG RAM I'K DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO 11101DI .CORP 5721 W96TH ST LOSANGELES CA 90045 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO <53 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
E�ALLv YEs❑NO CITATION# 3AO736757 FOLLOW VEHICLE TOO CLOSELYorrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:6032643007
LAST NAME SHI FIRST NAME SONGTAO MIDDLE
INITIAL
17❑ STREET Is❑' 1222 S 47TH PL CITY' RENTON ST WA ZIP 98055 37
NEW ADDREs
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 M M D.C.B. 12 _ 14 1986 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CKE8523 TATE 41
WA VIN# 7SAXCDE55PF413872 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
Gov HI
VEH YEAR 2023 MAKE TESL MODEL X STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY 44
ES YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE 936218182IN 1 9TOP
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES N�
25❑ J s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
BENJAMIN FLICK 12825 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE16419
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12722
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(LAST FIRST,MIDDLE INITIAL) XU QING
ADDRESS&PHONE#
RENTON SEXi F MMaoYyvv 08 - 17 - 1985
PASSENGER Z WITNESS 'UNIT# j 2 POS 3 AIRBAG 1 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES
USE 2 CLASS
'1
NAME
(LAST,FIRST,MIDDLE INITIAL) SHI AIDEN
ADDRESS&PHONE# D O B
RENTON SEX' M MMaovvvv O6 _ 27 _ 2017
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 2 PCS 7 AIRBAG 2 RESTR. 12 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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 11-04-23 05:54 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 111412023 6:48:35 PM
BADGE OR ID# 12825 OR]#' WA0171300 TIME POLICE DISPATCHED; 4:15 PM TIME POLICE ARRIVED]4:20 PM
PART I PAGE IT]OF 4�
REPORT NO. EE16419 CASE# 23-12722 OF COLLISION
11/04/23 16:09
OF CbLLI510N
NARRATIVE
23-12722
On 11-04-2023 at approximately 1615 hours I was working a Renton Police Department patrol in full
uniform in the city of Renton, King County, State of Washington. I responded to a motor vehicle
collision in the 17300 block of Benson Dr S.
Upon arrival I made contact with both parties involved. Both drivers agreed upon the circumstances
that occurred. The involved units and drivers were identified as follows:
Unit 01 (CA/22740S3) driver Ian D. Carlone (DOB: 11-09-1986 via CADOL)
Unit 02 (WA/CKE8523) driver Songtao Shi (DOB: 12-14-1986 via WADOL)
Both involved units were southbound on Benson DR S from Benson RD S.
Unit 02 was stopped for traffic in in the 17300 block of Benson DR S. Unit 01 rear-ended unit 02.
Driver Carlone told me that he had been distracted and accidentally rear-ended unit 02.
1 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 Carlone had been following too closely
as he was not able to stop in time once he looked up from his distraction. I confirmed with driver
Carlone that his DOL address in Florida was his current mailing address. I informed him that he would
be receiving a citation for following too closely 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 11-04-2023 in Renton, WA.
PAGE 3 OF 4
REPORT NO.! EE16419 CASE# ' 23-12722 DATE AND TIME 11/04/23 16:09
OF COLLISION
17300 block Benson DR S
10
PAGE 4 OF 4