HomeMy WebLinkAbout25-1425 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-1425 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2� 1 1 7 28
TOTAL#OF OBJECT
TRIBAL UNITS 02 STRUCK' TREE OR STUMP
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 02 - 1-- 2025 1425 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR BLOCK NO. e✓ 2000
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET MILES e S B W e S 21ST ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252716141 0 11
30
6� LAST NAME NELSON FIRSTNAME LEWIS MIDDLE G 1 1 2 31
INITIAL
STREET 01 754 QUEEN AVE NE CITY RENTON ST WA ZIP 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEXI M MIDI Y' 11 - 02 - 1946 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 1 RESTR 4 EJECT 1 H USE CLASS 6 LACERATION TO LEFT LEG 2❑
3
10 9❑ P1 AT 14 BF61623 STATE WA VIN# 1FAPP6043NH140543
---- TRAILER STATE PLAT Eft STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 4 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 5 1
13 34
4 1992 FORD THUNDE 2D DAMAGE vEsNo �LII� RS YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 930232695 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY Yes❑NO❑ CITATION# <1�3
OTTOM
15❑ STAIN,DIING 7 6
UNIT U2 vEHIMOTOCLE CYCLE ❑ PEDESTRIAN ❑ OWNFR PEDAL RTY ❑ DYES NO OLD MET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY RENTON ST ZIP
17❑ NEW ADDRESS ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX U MMDDYY 39
WELMET 1NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
❑21❑ LICENSE TATE VIN# 41
PLATE#
42
22❑ PIR I I TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED By Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO (NEWJ RENTON VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# J AGENCY
26
R.ON/SHl 5738 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF66360
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1425
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'
Unit 2 found off roadway, down embankment, and stopped nose first into a tree east of Benson Dr S.
Driver 2 Nelson suffered a left leg laceration, and was short of breath when 1 arrived. Fire personnel
found that his blood pressure was elevated, and dressed leg wound. Nelson was transported by
ambulance to Valley Medical Center. Nelson told me that he was "clipped" by an aggressive vehicle,
which he only remembered as dirty white. Nelson told me that this vehicle had aggressively tailed him
north on Talbot Rd S, then through the left turn onto northbound Benson Dr S from S 21st St. Nelson
said that as he exited the turn, he thought that the car had bumped him from behind, causing him to
fishtail, swerve to avoid another car, and then leave the roadway. No other car found, but roadway
surface was unusually slick throughout the area, possibly from de-icing compound. After leaving
roadway, Nelson's car crossed sidewalk, then about 50 feet down a grassy embankment before
hitting a tree. Nelson's car towed by Bankers Towing. Photos of the scene uploaded into
Evidence.com.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Surface Condition: ROAD SLIPPERY WITH UNK SUBSTANCE
**** END OF AUTO-POPULATED SECTION ****
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 02-13-25 04:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 211712025 3:48:46 AM
BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 2:27 PM TIME POLICE ARRIVED;2:27 PM
PART I PAGE IT]OF 3�
REPORT NO. EF66360 CASE# ' 25-1425 DATE AND TIME 02/13/25 14:25
OF COLLISION
t` c
i
i t
ai
i
2 z 4 t S7
}
{
y
}Is{
l 1
4
S
vt
a
PAGE 3 OF 3