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HomeMy WebLinkAbout24-11759 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF38796oc� RA COLLISION REPORT 1591971 CASE# 24-11759 2 INTERSTATE CITY STREET FIRE I RESULTED STOLENSTATE ROUTE OTHER VEHICLE LQCAI-AGENCY 4100 3 HIT&RUN CODING COUNTY RD PRIVATE WAY ❑ INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E eDL�ISION' 11 - 12 - 2024 2040 17 =.�� S W OF 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ S PUGET DR BLOCK NO. e 2000 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------ 1.1 FEET e S 8 W e BENSON RD S 0 1 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2065180119 0 3 30 6 LAST NAME FORSHEE-SETZER FIRST NAME LAUREN MIDDLE J 1 1 2 31 INITIAL STREET ] 16642 127TH AVE SE CITY; RENTON ST I WA Zlp; 98058 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO INTERLOCKVEs NK7 YES NO 8 DRIVER # STATE WA SEXI F MMDDYY' 09 — 01 — 1994 1 2 32 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY',1 NATURE of INJURIES 2= 10 PI ENSrtEI BWR9167 STATE WA VrN JNIBJICR9JW282663 3 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM To TRLR TRLR 7 1 3 33 12 0 0 mN#' vIN# FROM TO VEH.YEAR 201a MAKE NISS MODEL ROGUE STYLE UT VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34 13� DAMAGE YES II_II NO `/ YESII_I) NO REGISTERED OWNER INFO LAUREN SETZER 16642127TH AVE SE RENTON WA 98053 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 2 3 4 14 PEMCO CA2090407 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE 5 36 Lemur YES[:]NO[:] CITATION# i o 80TTOM 15❑ sTnNowc s 7 e MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ nWNER D:2533914071 16� LAST NAME 7NEW7MCCAMMON FIRST NAME DAVID MIDDLE L INITIAL 17 F1 STREET ❑ ❑ 17221 125TH AVE SE CITY RENTON ST, WA ZIP 98058 q 37 NEW ADDRESS 1$❑ CDL IGNITION REQUIRED3 IGNITION PRESENT MEDICAL TRANSPORTED') 38 INTERLOCKYEs No INTERLOCI£YES z5 YEs NO 19 DRIVERS STATE WA SEX U I D.O.B. 1 04 25 1958 � 39 LICENSE# MMDDYY — : NATURE OF INJURIES 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 USE HELMET 2 INJURY 40 CLASS 0 ❑ 21 ILICENSE PATE# BWB9757 rare WA vIN# USE 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2020 MAKE CHEV MODEL EQUINOX STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO REGISTERED OWNER INFO DAVID MCCAMMON 17221125TH AVE SE RENTON WA 98058 D:2533914071 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO PEMCO CA0487624 IN EFFECT &POLICY# I STOP HICLE'EILe L YES❑ NJ—I, CITATION11 CHARGE to BOTTOM VE 25 s s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 KEITH PETTY 12809 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF38796 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11759 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I 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. KEITH PETTY 11-12-24 11:08 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED APPROVED BY DATE DESIREE SCOTT 10272 1112312024 9:53:18 AM BADGE OR ID# 12809 ORI# WA0171300 TIME POLICE DISPATCHED 1 8:40 Pry] TIME POLICE ARRIVED i 8:44 PM PAST B a Do-3m5—attar(t 1Mff) PAGE 2�OF F6 REPORT NO. EF38796 CASE# 24-11759 OF DATE AND r�N + 11/12/24 20:40 O�COLLISION NARRATIVE 24-11759 On 11/12/2024 at approximately 2040 hours I was working for the city of Renton as a police officer. I was dispatched to the intersection of S Puget Dr and Benson Rd S in the City of Renton County of King State of Washington for vehicle accident. Upon arrival I contacted (V1) Lauren Jennett Forshee-Setzer (DOB 09/01/1994) driving her gray 2018 Nissan Rogue Sport (BWR9167/WA) VIN/JNIBJICR9JW282663, and (V2) David Lee McCammon (DOB 04/25/1958) identified by his WADL. David was driving his Gray 2020 Chevrolet Equinox (BWB9757/WA) VIN/2GNAXSEV5L6264639. David had his wife Rebecca Ann McCammon (DOB 08/05/1959) riding in the front passenger seat. V2 was heading east bound on S Puget Dr attempting to turn south onto Benson Rd S at the intersection. V2 stopped to clear the intersection before making the turn when V1 collided into the back of V2. There was minimal damage to both vehicles. The passenger of V2, Rebecca McCammon had complained of pain and requested to be seen by RRFA. The RRFA responded and cleared Rebecca at the scene. No injuries were visible. I provided both parties with my business card with the case number. This incident was captured on my body worn camera. This report is a summary of the events that occurred and is not an exact sequencing of events. Statements have been paraphrased and summarized. "I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct." Electronically signed: K.Petty, Date: 11/12/24 at 2256 hours, Place: Renton, King County, WA PAGE 3 OF 6 REPORT NO. EF38796 CASE# 24-11759 O OF COLLI r�510NN + 11/12/24 20:40 COLL1 NARRATIVE PAGE 4 OF 6 REPORT NO. EF38796 CASE# 24-11759 O OF COLLI r�510NN + 11/12/24 20:40 COLL1 NARRATIVE PAGE 5 OF 6 REPORT NO. EF38796 CASE# 24-11759 DATE AND TIME 11/12/2420:40 OF COLLISION x �t k �{ 1{ 5 5 { + rf ?2 p 5 p , � �Z r' Sr a 5.4 9y { Z A S Y l t' 3 Y R@ 44\ PAGE 6 OF e