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COLLISION REP FIT 1591971
CASE 24-10903 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 2 TOTAL#OF OBJECT 1 $ 6 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
COLLISION.. 10 - 19 - 2024 1734 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
116TH AVE SE BLOCK NO. e✓ 16900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2067590359 0 11
30
6� LAST NAME TESFAMICHAEL FIRSTNAME AWET MIDDLE 1 2 31
INITIAL
STREET ❑ 25805 115TH AVE SE APT G202 CITY KENT ST WA ZIP 98039 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9� P1 ATE 14 0647 STATE WA uN# 2T1BU4EEXDC124927
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. FROM TRLR 1 $ 33
12 3 $ VIN#' VIN#
TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY
13 $ GOVT.VEHICLE 1 $ 34
2013 TOYT COROL SD DAMAGE YES NO YES❑ NO
REGISTERED OWNER INFO YOSIEF HASTE 21121105TH PL SE KENT WA 98031 D:2067590359 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE Z INSURANCE CO PROGRESSIV 984481215 3
IN EFFECT &POLICY# 9TOP
VEHICL' CHARGE 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4255299778
16 a
LAST NAME PIPKIN FIRST NAME CHRISTINA MIDDLE
INITIAL
17 STREET I❑ 16230 114TH AVE SE CITY' RENTON ST WA ZIP 98055 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NOF,/
19 STATEWSEXFD.O.B.
OB. _ _ 39
LICENSE# M .
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLA E# 8212875 TATE GOV VIN# USE
1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VN VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24 DAMAGE YES NO OWNER YES NO
REGISTERED OWNER INFO POSTAL SERVICE US 17200116TH AVE SE RENTON WA 98055 D:4255299778 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO TORT CLAIMS 253-214-1774IN STOP 5
1 0(
—ICLE ❑ ,J� CITATION# CHARGE
25 ' a to BOTTOM
LEGALLY YES N`L J
=AS
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 SWAN 7 12965 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF31943
COLLISION REPORT III III III III III 111
1591972 CASE# 24-10903
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.
NICHOLAS SWAN 10-20-24 02:26 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 111412024 1:47:34 PM
BADGE OR ID# 12965 ORI# WA0171300 TIME POLICE DISPATCHED; 5:34 PM TIME POLICE ARRIVED',5:34 PM
PART I PAGE IT]OF 4�
REPORT NO. EF31943 CASE# 24-10903 OF COLLISION
10/19/24 17:34
OF CbLLI510N
NARRATIVE
#24-10903
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 10/19/2024 at approximately 1734 hours I was on routine patrol and saw a two vehicle motor
collision that had recently occurred in the 16900 block of 116th Ave SE in the city of Renton, King
County, WA. All drivers were on scene and there were no injuries.
I arrived and found both vehicles pulled off to the side of the road on 116th Ave SE. When I arrived I
found Unit 1 a white USPS mail van with ID: 8212875 and Unit 2 a silver Toyota Corolla WA LIC:
CHS0647. Both drivers were wearing their seatbelts and had no injuries.
Driver 1 of Unit 1 was traveling south bound on 116th Ave SE. The driver told me she was reaching in
a mail bin when she looked up and saw the driver in front of her applying it's brakes. She applied her
brakes, skidded and collided with the rear of Unit 2.
Driver 2 of Unit 2 said he was driving south on 116th Ave SE. He had applied his brakes and Unit 1
hit the back of his vehicle. He stated he was pushed into the back of the vehicle in front of him. The
vehicle in front of him did not stop though and there was no apparent damage to the front of Unit 2.
Unit 1 had to be towed from the scene. The vehicle was towed by their own personal tow service.
Unit 2 was able to drive away under it's own power.
I took photo of the damage to both vehicles and uploaded them to Axon.
At the conclusion of my investigation, I determined that the proximate cause of the collision is due to
Unit 1 not paying full attention to the road in front of them and being distracted by items inside the
vehicle.
If Unit 1 was not distracted, this collision would not have occurred.
Both drivers had valid vehicle insurance and were provided an exchange of information.
This concludes my report.
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 Officer N. Swan #12965 on 10/19/2024 at 1819 hours in the City of Renton.
PAGE 3 OF 4
REPORT NO. EF31943 CASE# ' 24-10903 DATE AND TIME 10/19/24 17:34
OF COLLISION
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PAGE 4 OF 4
