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HomeMy WebLinkAbout24-11793 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 24-11793 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 3 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 RESERVATION STRUCK z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CowsloN 11 - 1-- 2024 1858 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BENSON RD S BLOCK NO. e✓ 1000 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 2 8 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El ,/No D:4257574322 0 11 30 6� LAST NAME NIXON FIRSTNAME RYAN MIDDLE D 1 2 31 INITIAL STREET ❑, 29419 112TH AVE SE CITY AUBURN ST WA ZIP 98092 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID -O B 08 1- 15 - 1975 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE ET ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 LICENSE CFG3395 sTArI WAurN# YS3FD49Y971135926 10 F91 PI ATE# TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. YRLR. $ 1 33 12 3 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 $ 34 13 2 2007 SAA 9-3 SD DAMAGE vEs 0NO f �AWkkRS vEs❑ No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 4 14 2 ABILI V INSURANCE INSURANCE CO PROGRESSIVE 960521814IN EFFECT &POLICY# TOPVE"'CLE CHARGE <1�3 OTTOM 5 36 LEGALLY YES❑NO❑ CITATION# 4A0852968,4A0852968, NO VALID OPER LICENSE WITH 15❑ STANDING 7 6 MOTOR PEDAL-: PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:3612322344 16 a LAST NAME GREENHOUSE FIRST NAME ALEX MIDDLE R INITIAL 17 STREET❑ NEW ADOREss❑' 1411 GRANT AVE S APT B303 CITY RENTON ST WA ZIP 980556002 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NO INTERLOCK v�Esl I I NOF YEs t l NO� 19� D IVERI # STATE WA ]SEX IF Mr D.O.B. 01 08 _ 1993 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40 ❑21❑ PLATE# CGH0230 TArE 41 WA VIN# JTDKN3DU1B0285335 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. N#. 43 RLR 'I TOWED By Gov HI 44 VEH YEAR 2011 MAKE 7'Oy7' MODEL pRIUS STYLE 3P —FEHICLE TOWED✓ NOO BLIN BANKERS YES No�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO USAA 010578653CIN STOP 5 VEHICLE ❑ C ] CITATION# CHARGE i o BOTTOM LEGALLY YES N[: 6 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 STEVEN FAJARILLO 12847 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF38795 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11793 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) BHATHAL MAN/NDERJIT K (LAST FIRST, ADDRESS&PHONE# D O.B. 24311 106TH PL SE KENT WA 980305409 SEXi F MMDOYyry 12 - 04 - 1998 PASSENGER I�I WITNESS UNIT# 3 POS 3 AIRBAG'2 RESTR. 4 EJECT ? 1 HELMET LASS NAruRE of INJURIEs L�!1 USE :CLASS '1 NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# Ly O B SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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. STEVEN FAJARILLO 11-14-24 12:26 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE DESIRES SCOTT 10272 1 1112312024 9:53:06 AM BADGE OR ID# 12847 ORI# WA0171300 TIME POLICE DISPATCHED! 7:02 Pry] TIME POLICE ARRIVED',7:03 PM PART Ei PAGE IT]OF REPORT NO. EF38795 CASE# 24-11793 OF COLLISION 11/13/24 18:58 OF CbLLI510N NARRATIVE 24-11793 This incident was captured on my body worn video camera. This report is a summary of events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. On 11-13-2024 1 was working as a police officer in the city of Renton. At approximately 1902 hours I was dispatched to the report of a collision at the 1000 block of Benson Rd S, City of Renton, County of King, WA. According to the notes in the call, a 3 to 4 motor vehicle collision occurred. There were unknown injuries. I arrived on scene where multiple officers were already on scene. The Renton Fire Authority was on scene evaluating for injuries. They cleared and advised me the involved parties were medically cleared. I contacted the driver of Unit 1. He told me he was driving north on Benson Rd S and lost control negotiating the curve and collided with Unit 2 and Unit 3. Both Unit 2 and 3 were travelling south on Benson Rd S. Both drivers of Units 2 and 3 said they were travelling south, and Unit 1 collided with them. Sergeant Thielman took photographs of the scene and vehicles and uploaded them to Evidence.com. I provided all involved parties with a case number. Unit 1 and Unit 2 were towed by Bankers Towing. Unit 3 was drivable and left the scene. The driver of Unit 1 was issued a notice of infraction for no proof of valid insurance, no valid operator license with identification, and speeds too fast for conditions. The driver of Unit 1 drove around a corner and was unable to maintain its lane of travel, subsequently colliding with Unit 2 and Unit 3. Unit 1's inability to maintain its lane was the proximate cause of the collision. There is no further information available at this time. I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Electronically signed by S. Fajarillo #12847 on 11/13/2024 @ 2336 hours in Renton WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EF387955 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 24-11793 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN � OWNER � YES� NO D:2064768334 0 1 29 LAST NAME KHATRA FIRST NAME NAVDEEP MIDDLE INITIAL STREET 30 NEW AnDRFSP' 24311 106TH PL SE CITY KENT ST WA ZIP 98030 6 ❑ 1 1 2 31 CDL GNITION REQUIRED GNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO NTERLOCK YES❑N0� YEs N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv', 07 - 08 - 1997 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE BZE7943 [TAT WA VIN# 1C4HJXDG6MW741384 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN It VIN.#. 11 3 5 VEH.YEAR2021 MAKE JEEP MODEL WRANGL STYLE UT VEHICLE TOVVE E T SABLIN TOWED BY anvi vEH1I' P FROM TO DAMAGE YES 'E YES NO REGISTERED OWNER INFO OWNED BY DRIVER 1 5 33 12 � SHADE IN DAMAGED AREA 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO SAFECO X6419506 R"i"Olx IN EFFECT &POLICY# VEHICLE 34 13 ❑ Lecnuv YES❑ NO❑ CITATION# CHARGE gg�@ 10 BOTTUM STANDING } l:9 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNER YE YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME NIITIA 36 L ❑ STREET"[-] 16 NEW nnR CITY ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No INTERLOCK YEs NO YEs NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE TAr VIN# 39 PLATE# 20 ❑ TRAILER' TRAILER El40 PLATE#< STATE PLATE# STATE 21 ❑ ❑ 41 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. STEVEN FAJARILLO 11-14-24 12:26 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 ORID# 12847 O#I',WA0171300 APPROVED BY 11123/202 PAGE F41 OFF 3000-345-013(R 11118) REPORT NO. EF38795 CASE# ' 24-11793 DATE AND TIME 11/13/24 18:58 OF COLLISION CD U) CD (D 0 0 PAGE 5 OF 5