HomeMy WebLinkAbout23-13975 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13975 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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# ❑
cawsloN 12 - 1-- 2023 1759 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR SOUTH BLOCK NO. e✓ 1500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 3831. 00 FMILES EET e S B W e SOUTH PUGET DRIVE
0 1 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ,/NO D:2067991367 0 7 30
6� LAST NAME CHOI FIRSTNAME XIAO MIDDLE L 1 1 2 31
INITIAL
STREET ❑, 5203 116TH AVE SE CITY BELLEVUE ST WA Zjp, 980063315 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATE 409YER sTATI WAurN#' 2HGES16561H559978
11[-� TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# ROM ro
TRLR. TRLR. 5 1 33
12 4 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE J 9 34
13 2001 HOND ClV4D 4D DAMAGE YES NO �MEYERS YES❑ NO✓
REGISTERED OWNER INFO ON TAK 11015203116THAVE SE BELLEVUE WA 98006 D:2067991367 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILI INSURANCE[Z INSURANCE CO STATE FARM 2695873-F28.47N 3 4
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
ALLv YES❑NO❑ CITATION# W23067375 FOLLOW VEHICLE TOO CLOSELY o eorrom
15❑ E STANDING 7 6
MOTOR PEDAL ❑ PEDESTRIAN PROPERTY ❑ DAM THR PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ OWNER YES 1/ NO OLD MET D:2062404136
16 a
LAST NAME HAYNES FIRST NAME GAIL MIDDLE E
INITIAL
17 STREET I❑ S❑' 25131 98TH PL S APT E302 CITY' KENT ST WA ZIP 980306161 4❑ 37
NEW ADDRES
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs It I NOF YES t l NOF,/
19 F] LDI IVEW # STATE WA ]SEX IF M .C... 02 _ 17 1954 39
20 ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 WEB SET 2 NJAU Sy 6 [-�A—TUREOF INJURIES C/O HEAD,NECK,AND SACK PAIN 40
❑ILICENSE 21❑ PLA E# BUE5088 TATE 41
WA VIN# 1J4GL58K94W268826 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
TOWED BY GOV HI 44
VEH YEAR 2004 MAKE JEEP MODEL LIBERTY STYLE $V DAMAGE TO WED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO PEMCO CA 0317240IN 1 9TOP
VE""LE CITATION# CHARGE
LEGAL
25 i o BOTTOM
LY YES NEB
❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 77P�
26MATTHEW NUGENT 11498 1300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE32469
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13975
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.
MATTHEW NUGENT 12-06-23 12:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/20/2023 10:11:02 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 6:03 PM TIME POLICE ARRIVED 6:08 PM
PART I PAGE IT]OF 4�
REPORT NO. EE32469 CASE# 23-13975 OF COLLISION
12/05/23 17:59
OF CbLLI510N
NARRATIVE
23-13975
On 12/05/2023 at approximately 1811 hours, I was dispatched to a blocking vehicle collision with
reports of injury in the 1500 block of Benson Drive South (JSO South Puget Drive), within the City
Limits of Renton, County of King, State of Washington.
While en route, Dispatch advised that one of the involved party's was complaining of head pain
therefore the Renton Regional Fire Authority (RRFA) was also dispatched to respond.
Upon arrival, RRFA was just arriving on scene to evaluate the involved parties. All involved parties
were evaluated and released at the scene. Officer E. Sim and I were able to collect each involved
party's information and independent summary of their involvement in the collision.
The driver of Unit#1 said she was traveling northbound in the 1500 block of Benson Dr S in lane 1 of
2. The driver of Unit#1 stated she was traveling directly behind Unit#2. The driver of Unit#1 stated
that Unit#2 came to a stop for traffic in the roadway and that Unit#1 subsequently collided with the
rear of Unit#2 causing significant damage to the front of Unit#1.
The driver of Unit#2 said she was the sole occupant of her vehicle and was also traveling northbound
in the 1500 block of Benson Dr S in lane 1 of 2. The driver of Unit#2 stated that she had come to a
stop for traffic that had queued at the upcoming intersection. The driver of Unit#2 stated that while
stopped, Unit#1 collided with the rear of Unit#2 causing moderate damage.
Based on the above statements, I determined that the Driver of Unit#1 (Choi) was the predominant
factor for the cause of collision due to Choi not paying attention to traffic in front of her and was too
close to the traffic directly in front of her vehicle causing a collision.
I issued Choi a written warning for Following Too Closely.
Unit#1 had to be impounded due to extensive damage. Unit#2 was able to be driven away without
further incident. An exchange of information was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 11:54 AM 12/6/2023 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EE32469 CASE# ' 23-13975 DATE AND TIME 12/05/23 17:59
OF COLLISION
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