HomeMy WebLinkAbout24-6682 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
INTERSTATE ❑ CITY STREET FIRE ❑
CASE 24-ss82 z
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CtLLISION' 06 - 1-- 2024 1705 17 ❑.= S 8 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
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:9512304660 0 11
30
6� LAST NAME NEICE FIRSTNAME MADISON MIDDLE M 1 1 2 31
INITIAL
STREET ❑✓ 10930 SE 172ND ST#G-101 CITY RENTON ST WA ZIP 98055 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 3 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� 8XEU772 sTArI WAvIN# KNDCE3LC9H5052196
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 1 $ 34
13 2 2017 KIA NIRO UT DAMAGE YES NO MEYER YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
<53 414 2 LIABILITY INSURANCE INSURANCE COIN EFFECT &POLICY# TOPVEwcLE CHARGE TTOM 5 36
LEc'C YES NO CITATION# 4AO194741 OP MOT VEH W/OUT INSURANCE,NO
15❑ STANDING 6
MOTOR PEDAL-: 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:2064320148
16 a
LAST NAME GRIMES FIRST NAME KIANI MIDDLE A
INITIAL
17❑ NEW STREETREss❑' 11100 SE PETROVITSKY RD APT P-201 CITY RENTON ST WA Zip 98055 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK v�Es No� YEs NDF
19 D IVEW #
❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ PLA E# BUG9718 TArE WA vIN# 1GNKVJED9CJ300914 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2012 MAKE CHEV MODEL TRAVERS STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24 DAMAGE YES NO GENE MEYERS YES NO
REGISTERED OWNER INFO KIANI GRIMES 11100 SE PETROVITSKYRD APT P RENTONWA98055 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO FARMERS 188546500IN STOP 5
"'LE ❑ ,.I— CITATION# CHARGE io BOTTOM
LEGALLY YES N
25 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
GREGORY BILLS 1
12495 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE90620
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6682
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) STOVALL LAKEA
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
1041 S DIRECTOR ST SEATTLE WA 98108 7579273085 SEX M MMDOYyvv 04 - 01 -SEAT I I INJURY
1994
PASSENGER RV WITNESS UNIT# i 1 POS. 3 AIRBAG i 3 RESTR. 4 EJECT ? 1 H U SE 2 CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL) HUDSON AL/YAH D
ADDRESS&PHONE# D O B
11100 SE PETROVITSKY RD APT P-201 RENTON WA 98055 SEX F MMDovvvv 01 _ 09 _ 2021
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 9 AIRBAG 2 RESTR. 10 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.
GREGORY BILLS 06-24-24 07:15 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1 6/27/2024 2:43:36 AM
BADGE OR ID# 12495 ORI# WA0171300 TIME POLICE DISPATCHED! 5:08 PSI TIME POLICE ARRIVED 5:08 PM
PART I PAGE IT]OF 4]
REPORT NO. EE90620 CASE# 24-6682 OF COLLISION
06/24/24 17:05
OF CbLLI510N
NARRATIVE
On 06/24/2024 at 1708 hours I was dispatched to 2000 Benson Rd S, in the City of Renton, King
County, Washington. I was responding to a report of a vehicle collision.
While en route, dispatch advised the following: two vehicle collision, blocking Benson Rd.
In this report, Unit 1 refers to a black 2017 Kia Niro (CA/8XEU772), driven by Madison M. Niece
(DOB 09/10/1996, WA ID). Unit 2 refers to a black 2012 Chevrolet Traverse (WA/BUG9718), driven
by Kiani A. Grimes (DOB 05/14/1993, WA DL).
At approximately 1708 hours, I arrived on scene and observed both units 1 and 2 blocking the
southbound lanes of Benson Rd S. Unit 1 was perpendicular to the road and primarily blocking the
center lane of three lanes. Unit 2 was facing south, blocking the left lane of the three lanes. Unit 1 had
airbag deployment so I requested Renton Fire to evaluate the occupants. Both vehicles had
significant front end damage and were not drivable.
I interviewed both parties and determined the following:
Unit 1 was exiting the parking lot of the 76 gas station at 2022 S Puget Dr, intending to turn left
(north). The two right lanes were stopped for traffic, with cars obstructing unit 1's vision of on-coming
traffic in the left lane. Unit 1 initiated a left turn out of the parking lot and collided with unit 2, which
was travelling southbound in the left lane.
Unit 1 had a front passenger, Lake A. Stovall (DOB 04/01/1994). Unit 2 had a rear passenger in a car
seat, Aliyah D. Hudson (DOB 01/09/2021).
Niece, the driver of unit 1, said she did not have insurance. She provided a Washington ID card.
When I ran her name in ACCESS her driving status showed "not licensed -eligible."
I advised Niece she would receive a ticket in the mail for operating a motor vehicle without insurance
and no valid operator's license with ID.
Gene Meyer towing responded to tow both vehicles. Niece left the scene when her friends arrived,
and did not remain on scene to speak with the tow operator. Because she had left the scene and her
vehicle was still in the road, I completed an impound form so Gene Meyer could tow the vehicle.
This concludes my involvement in this case.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Ofc. Gregory Bills #12495, 06/24/2024 at 1903 hours in Renton, Washington.
PAGE 3 OF 4
REPORT NO. EE90620 CASE# ' 24-6682 DATE AND TIME 06/24/24 17:05
OF COLLISION
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