HomeMy WebLinkAbout24-6665 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 24-6665 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT ❑2$
TRIBAL UNITS 01 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. 06 — 24 — 2024 0658 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON RD S BLOCK NO. e✓ 1400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e UTILITYRD
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2068504239 30
6� LAST NAME CAMACK FIRSTNAME MARQUELLA MIDDLE C 1 0 4 31
INITIAL
STREET ❑ 2223 BENSON RD S APT Q202 CITY RENTON ST I WA 2jp, 980558863 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/iNTERLOCKYEs NO INTERLOCKYEs NO YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 7 [NATURE OF INJURIES
SHOULDER AND HAND z❑
3
10❑ PI ATNE 14 BJt9325 sTAr WAvN# 1GNEK13Z42J270112
----� TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FRom To
TRLR. TRLR. 5 1
2❑ 33
1 VIN# VIN#
Rom 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE
13 4 2002 CHEV TAHOE UT DAMAGE YES NOBS YES❑ No✓
REGISTERED OWNER INFO MARQUELLA CAMACK 2223 BENSON RD SAPTQ202 RENTON WA 980558863 D:2068504239 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILIT INSURANCE❑ INSURANCE CO
IN EFFECT &POLICV# OTOP
ve FFE CHARGE ❑ 36
LE—Lft res❑NO❑ CITATION# BOTTOM
15❑ TANFl-
UNIT 02 VE IOOR ❑ CYCLE ❑ PEDESTRIAN ❑ PROPE OWNFRRTY ❑ 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❑ TArE LICENSE vIN# 41
1
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. '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
C.JACOBS 1953 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF03362
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6665
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NEEDHAM ANDREA M
(IAST FIRST,
ADDRESS&PHONE#
10952 SE 169TH PL RENTON WA 98055 2063130286 SEXi F MMDDvyry 05 - 27 - 1983
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) GILMORE JAYLE D
ADDRESS&PHONE# D O B
18920 131ST PL SE RENTON WA 98058 2532425449 SEX' F MMDpvvvv 10 _ 21 _ 1973
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
[]WITNESS POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 6-24-24 at about 0708 1 arrived in the 1200 block of Benson Rd S. for a 1 car rollover collision.
Officer was already on scene and talking to the witnesses. Driver 1, identified via WADL as Marquella
Camack was standing on the side of the road talking on the phone. Renton Fire Authority (RFA)
arrived a few minutes after I did and started to triage Camack. When Camack was finished with RFA
she told me; She was northbound on Benson Rd S, traveling around 40 mph when she saw the
vehicle in front of her stop suddenly for a vehicle that turned out in front of it. She believed she would
not be able to stop in time so she swerved to avoid the collision, that is when her vehicle started to
roll. She had scrapes and her arm, breast and shoulder hurt. She would self transport to the doctor.
She does not have insurance. Due to the disabling damage and Camack not having insurance the
vehicle was impounded. The impound was completed by Bankers towing. This concludes this report.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: SWEVING TO AVOID A COLLISION
**** 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.
C.JACOBS 08-07-24 02:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 8/8/2024 8:05:01 AM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 7:09 AM TIME POLICE ARRIVED',7:03 AM
PART I PAGE IT]OF 3�
REPORT NO. EF03362 CASE# 24-6665 DATE AND TIME 06/24/24 06:58
OF COLLISION
-^P4
1
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