HomeMy WebLinkAbout25-434 STATE OF I !�� I III I III I IIII III II I . 0 27c REPORT NO EF56032
COLLISION REP FIT
1591971
❑ ❑ RESULTED ❑ CASE zs-434 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 01 - 1-- 2025 1704 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FMILES NEET e S ❑ E e DUVALL AVE NE
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2063344155 0 11
30
6❑ LAST NAME NIU FIRSTNAME JIA-LIN MIDDLE 1 2 31
INITIAL
STREET ❑, 3660 FAIRWEATHER LN CITY MEDINA ST WA ZIP 98039 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs No YES No
8❑ LDICENSE# STATE yyq SEX'F MMDDYY 11 — 21 — 1956 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 6 DIZZINESS INJURY [NATURE OF
2❑
3
10 9❑ Pi ATE 14 CGt4259 STATE WA VIN# 7SAXCAE53PF390641
TRAILER STATE TRAILER STATE11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR N MAKE TESL MODEL MODEL STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO JIA-LIN NIU 3660 FAIRWEATHER LN MEDINA WA 98039 D:2063344155 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO TESLA TLA-CA-A-R-99923254
IN EFFECT &POLICY# 9TOP
15
VEHICLE 1 36
LEGALLY re6�No M CITATION# 5A0168914 CHARGE FAIL TO YIELD MOTOR VEHICLE )o eorrom
❑ STANDING ET 8 7 6
1.' MOTOR PEDAL PROPERTY DAM THR OLD M PHON
16 E
UNIT VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES�/ NO D.2539886150
a
LAST NAME SHEPARD FIRST NAME BENJAMIN MIDDLE T
INITIAL
17❑ STREET ❑', 6307 NE 1ST ST CITY RENTON ST WA ZIP 98059 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK yEs It I NOF YES
t l No❑
19 DRIVER'S STATE WA SEX M D.O.B. 11 24 1977 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I C41705D TATe I WA VIN# 5TFUM5F16FX060030
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE ILER# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
Gov HI
VEH YEAR 2015 MAKE 7'Oy7- MODEL TUNDRA STYLE TR DAMAGE TOWED NOO✓ BLIN TOWED BY 44
yES NO
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO SAFECO H2527432IN STOP 5
VEHICLE YES[:] NC[:]I CITATION# CHARGE to BOTTOM
LEGALLY
25 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
N.ODALOV/C 11628 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF56032
COLLISION REPORT III III III III III 111
1591972 CASE# 25-434
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SHEPARD JACK
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
REN7OJ1/ SEX M MMDDYYYY 01 - 08 - 2014
-------------------------
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER ZWITNESS�'UNIT# 2 POS 9 AIRBAG'2 RESTR. q EJECT USE CLASS +7 MARKS FROM SEATBELT
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER [:]WITNESSO UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY 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'
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.
N.ODALOV/C 01-13-25 06:30 PM
INVESTIGATING QFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 111412025 5:27:30 PM
BADGE OR ID# ! 11628 ORI#' WA0171300 TIME POLICE DISPATCHED 5:05 PM TIME POLICE ARRIVED 5:10 PM
PART I PAGE IT]OF 5�
REPORT NO. EF56032 CASE# 25-434 OF COLLISION
01/13/25 17:04
OF CbLLI510N
NARRATIVE
25-434
Unit 1 -WA Lic/CGL4259 maroon 2023 Telsa Model Y
Driver/registered owner of unit 1 -Jia-Lin Niu
Unit 2 -WA Lic/C41705D white 2015 Toyota Tundra
Driver/registered owner of unit 2 -Benjamin Shepard
Passenger-Jack Shepard
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 01-13-2025 at approximately 1705 hours I was dispatched to a collision that occurred just east of
NE 4th St/Duvall Ave NE. Both parties were waiting for police contact near Jack in the Box (4810 NE
4th St).
I arrived at approximately 1710 hours. I contacted Jia-Lin first and then Benjamin. A summary of how
the collision occurred is as follows. Benjamin was traveling from east to west on Duvall Ave NE
proceeding into the right turn lane to turn north onto Duvall Ave NE. The business plot entrance for
the 4800 block of NE 4th St has a driveway that he was approaching. Jia-Lin was traveling east on
Duvall Ave NE and entered the center turn lane to turn left into this driveway. Jia-Lin stated she
thought it was clear for her to turn left and didn't see Benjamin's vehicle. Jia-Lin stated he was
traveling more than the speed limit. Jia-Lin gave me a USB device that has Telsa vehicle recordings
on it. I was able to find the front and right-side recordings of her vehicle at the time of the collision
which I reviewed on my computer. The video clips show Benjamin's vehicle in motion entering the
right-hand turn lane before the impact occurred. I explained to Jia-Lin that she did not have the right
of way and needed to yield to Benjamin and the other vehicles in motion traveling from east to west.
Jia-Lin stated she felt dizzy but declined to be medically evaluated at the scene. Jack sustained
abrasions from his seatbelt but both he and Benjamin declined to be medically evaluated at the
scene. Both units sustained substantial damage. The Tesla sustained damage to the passenger side
and the Toyota sustained damage to the front end of the vehicle. Both vehicles were drivable.
Jia-Lin and Benjamin were identified by their WA DOL images. Jia-Lin was cited (#5A0168914) for
failure to yield and she was advised the citation would be mailed to her home address.
Images of both vehicles, Jack's abrasions and the Tesla camera footage which were uploaded to
evidence.com.
During this incident I was equipped with body-worn camera which records both audio and video.
Portions of the incident were recorded. This report is merely a summary of the incident and is not
intended to be an exact transcription of the entire investigation or what may have been captured with
the recording system.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by N. Odalovic#11628 on 01-13-2025 at 1820 hours in Renton,
WA.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
PAGE 3 OF 5
REPORT NO. EF56032 CASE# 25-434 OF COLLISION
01/13/25 17:04
OF CbLLI510N
NARRATIVE
Motor Vehicle Unit 1
Action Code: TURNING LEFT INTO BIZ COMPLEX
**** END OF AUTO-POPULATED SECTION ****
PAGE 4 OF 5
REPORT NO. EF56032 CASE# ' 25-434 DATE AND TIME 01/13/25 17:04
OF COLLISION
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PAGE 5 OF 5