HomeMy WebLinkAbout24-99 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE# z4-ss 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 8 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' FIRE HYDRANT
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. Of - 1-- 2024 0247 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON RD S BLOCK NO. e✓ 1977 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e EAGLE RIDGE DR S
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259023185 0 11
30
6� LAST NAME BUTTS FIRSTNAME ADRIANNA MIDDLE F 1 2 31
INITIAL
STREET ❑ 17803 118TH AVE SE CITY RENTON ST WA 2jp, 98058 2=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 9 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CKS8006 sTArI WAurN# JHMES26715S000146
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2005 HOND CIVIC SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO <53 4
LIABILITY INSURANCEIN EFFECT &POLICV# TOPVE— CHARGE OTTOM 5 36
EGALL'Y YES❑NO CITATION# 4A0022134,4A0022134, OP MOT VEH W/OUT INSURANCE, 5
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR PHONE
UNIT 02 VE OLD MET HICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068873445
16 a
LAST NAME NGUYEN FIRST NAME BRANDON MIDDLE P
INITIAL
17 STREET I❑ 1634 LAKE YOUNGS WAY SE CITY RENTON ST WA ZIP 98058 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YEs t l NO�
19 LICENSE# STATE WA SEX M M.O.B. 12 _ 14 2003 39
20❑ ON DUTY STATUS AIRBAG 6 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ LICENSE I PLA E# BJM7849 TArE WA vIN# 1J8HR48M78C174643 1
42
22❑ PLATE# STATE PLATE# STATE
T
23❑ VIN 43
IN##. IN RLR
' #.
VEH YEAR 2008 MAKE JEEP MODEL GRAND STYLE SI/ VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO GUY SODERLIND 3501 SW 171STST BURIEN WA 98166 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU POLICY#E CO PEMCO CA1984934IN STOP 5
'E""LE ❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY YES N`L J
25 ' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE45369
COLLISION REPORT III III III III III 111
1591972 CASE# 1 24-99
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) W/LSON DEMAREA C
(LAST FIRST,
ADDRESS&PHONE#
12806 SE 237TH PL KENT WA 98031 4255259241 SEX M MMDDYyry 07 - 01 - 2000
PASSENGER Z WITNESS j UNIT# j 1 PQS 3 AIRBAG 6 RESTR. 9 EJECT ? 1 H U SE 2 CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYV
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.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 01/04/2023 at 0248 hours I was dispatched to an unknown if injury collision at the 1900 blk of
Benson Rd S near the intersection of Eagle Ridge Dr S. I spoke with the driver of Vehicle 1 who
stated that she was traveling West on Eagle Ridge Dr S approaching the intersection of Benson Rd
S. Driver 1 stated that she stopped at the stop sign and then continued into the intersection. Driver 1
stated that she was attempting to make a lefthand turn with Vehicle 1 to travel South on Benson Rd S
from Eagle Ridge Dr. Driver 1 stated that when she turned South, the front bumper of Vehicle 1 made
contact with the front bumper of Vehicle 2. This was corroborated by both the damage to both
vehicles and the passenger in Vehicle 1. Driver 2 stated that he was traveling North on Benson Rd S
at around the 1900 blk approaching Eagle Ridge Dr S when Vehicle 1 turned South on Benson Rd S
from Eagle Ridge Dr S. Driver 2 stated that he did not have time to slow down or avoid the collision,
and the front bumper of Vehicle 1 made contact with the front bumper of Vehicle 2. It appears that
Vehicle 2 then lost control after the collision and maneuvered to the West side of the roadway,
striking a fire hydrant and uprooting it. Vehicle 2 then came to a final rest in the blackberry bushes on
the West side of the roadway. Vehicle 1 spun in place when contact between vehicles was made and
came to a rest facing East towards Eagle Ridge Dr S. Driver 2 provided me with his drivers license
and insurance for the vehicle which was registered to his step-father who was not on scene. Driver 1
stated that she did not have insurance or a valid drivers license but provided me with her name and
updated address. Upon a check of DOL it showed that Driver 1's drivers license was cancelled. Both
parties appeared uninjured and said they may seek medical attention later after being evaluated on
scene by Renton Regional Fire Authority (RFA). I provided both parties with an exchange of
information form.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 01-04-24 04:10 AM
INVESTIGATING QFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 1/29/2024 8:56:41 AM
BADGE OR ID# 12509 OR]# WA0171300 TIME POLICE DISPATCHED 2:48 AM TIME POLICE ARRIVED 2:50 AM
PART I PAGE IT]OF
REPORT NO. EE45369 CASE# 24-99 DATE AND TIME 01/04/24 02:47
OF COLLISION
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