HomeMy WebLinkAbout24-1077 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
SASE 24-1077 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 6 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 01 - 1-— 2024 0805 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON RD S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e SE 168TH ST
❑ �
0 1 29
MOTUNIT U1 VEHIOR Z PEDAL-CLE CYCLE ElDESA✓NHORESHOLD MET PHONE 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
DRIVERS
STATE SEX D '❑- 328 LICENSE MMDYY❑
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
rRLR. TRLR. 5 1 33
12❑ VIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO [NEW] VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE 5 36
LECALLv Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063277119
16 a
LAST NAME BENNETT FIRST NAME TIFFANY MIDDLE I L
INITIAL
17 STREET❑ NEW ADOREs7 910 22ND AVE CITY' SEATTLE ST WA ZIP 981224808 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT tSENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NoR INTERLOCK YES It1 I NOF YES l NO❑
19 LDIIVE # STATE I SEX F M .C.B. 05 _ 25 _ 1985 El 39
20 ON DUTY STATUS 1 AIRBAG RESTR EJECT 1 H EET 7 NJAU SY 6 [NATURE.1 INJURIES
R ARM R FOREHEAD L HAND ❑ 40
❑21❑ LICENSE TATE vIN# 41
`1
PLATE#
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
24❑ 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 IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26 4 9 M.LEVERTON 2517 0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE46395
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1077
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.
M.LEVERTON 01-31-24 02:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 21112024 2:50:45 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED: 8:05 AM TIME POLICE ARRIVED',8:08 AM
PART I PAGE IT]OF 4�
REPORT NO. EE46395 CASE# 24-1077 OF COLLISION
01/30/24 08:05
OF CbLLI510N
NARRATIVE
Within the city limits of Renton/King/WA I responded to a car v bicycle crash hit and run near the
intersection of 108th Ave SE at SE 168th St.
I contacted the victim/bicycle at 2640 Benson Rd S in the admin office. She had a bandage on her
forehead when I arrived. She told me she was riding on the sidewalk towards work when she was hit
on the side by a passing car. She did not provide any additional information for that vehicle. She said
she had on a helmet and was using a headlight. Another officer went back to the area of the crash to
locate those two items with negative results. There was damage on the right hand grip and some rub
marks on the tire, but no clear/obvious paint transfer or other indicators of contact from the hit and run
vehicle.
Bennett did not provide any information other than she was near the light at the listed intersection.
She said she was on the sidewalk when hit. She did not provide a location or side of the road she
was on during POI. In fact she provided very little information.
There was no video captured in the area of the crash and no witnesses either.
Bennett was transported to Covington Urgent care, under protest by a co-worker.
Information/Insurance only.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 1/31/2024
PAGE 3 OF 4
REPORT NO. EE46395 CASE# ' 24-1077 DATE AND TIME 01/30/24 08:05
OF COLLISION
S. cene not obse r. ed
PAGE 4 OF 4