HomeMy WebLinkAbout24-6499 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
SASE 24-6499 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 O 7 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'. 06 - 1-— 2024 1543 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 ❑ VV e 108THAVE SE
0 5 29
MOTR PI PEDAL-UNIT 01 VEHICLE CYCLE ElYES
A�NOGE ESHOLDMET PHONE 0 1 30
6� LAST NAME FERNANDEZ FIRSTNAME REBECCA MIDDLE / 1 2 31
INITIAL
STREET ❑ 201 TAYLOR AVE NW APT 103 CITY RENTON ST WA Zjp, 980575139 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'F MID
.O B 03 1— O6 — 2004 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� BMB2679 sTArI WAVrN# 1FMCUOF74JUC36355
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2018 FORD ESCAPE DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO FRANCISCO FERNANDEZ 9218 S K ST TACOMA WA 98444 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE INSURANCE CO STATE FARM 412 1485 F09 47C 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING 8 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES NO SOLD MET PHONE
16 a
LAST NAME NEWMAN FIRST NAME REGGIE MIDDLE I L
INITIAL
17❑ STREET ❑', 17013 105TH AVE SE CITY RENTON ST WA ZIP 980555443 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 LDIIVEW # STATE WA SEX M M .C.B. 07 01 1946 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE AHF2176 TAre 41
WA VIN# 4S3BL616797222934
❑
pLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2009 MAKE SUBA MODEL LEGACY STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DEMETRIUS GREENHOUSE 830 PIKE ST NE APT A7AUBURNWA98002 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&POLICY#E CO USAA 015609787IN 9TOP 5
'E""LE ❑ ,J CITATION# CHARGE to BOTTOM
LEGALLY YES Nu
25 ' e
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE97367
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6499
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DEROSE FRANCS J
(I.P.ST FIRST,
ADDRESS&PHONE#
831 S ClOVERDALE ST SEATTLE WA 98108 7246839078 SEX M MMDDYyry 10 - 29 - 1993
PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
[:]WITNESS�' POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On June 20, 2024, at 1543 hours dispatch requested that I respond to a collision at the intersection of
Benson Rd S and 108th Ave S, in Renton.
Upon my arrival I spoke with the driver of unit 2 and he explained that he was following unit 1
northbound on Benson Rd S from Benson Dr S. As they approached 108th Ave S, unit 1 made a U-
turn which affected unit 2's ability to slow down. The driver of unit 2 said they were unable to stop in
time, so they struck unit 1's drivers side doors.
I then spoke with a witness, and they told me they were following the two vehicles northbound on
Benson Rd S. As they approached 108th Ave SE, unit 1 made an unexpected U-turn and
subsequently unit 2 struck unit 1. The witness mentioned they were confused to why unit 1 would
make a U-turn when oncoming traffic was so close.
I then spoke with the driver of unit 1 and they told me they did make a U-turn near 108th Ave SE, but
they were struck by unit 1 as she attempted her turn.
Based on the information gathered I believe unit 1 made an improper u-turn, which contributed the
collision occurring.
I provided me information and case number to the two drivers. I also gave them a copy of the
exchange of information.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 06-26-24 10:29 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 711912024 1:58:26 PM
BADGE OR ID# 12007 OR]# WA0171300 TIME POLICE DISPATCHED 3:48 PM TIME POLICE ARRIVED';3:57 PM
PART I PAGE 2�OF❑
REPORT NO. EE97367 CASE# ' 24-6499 DATE AND TIME 06/20/24 15:43
OF COLLISION
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