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HomeMy WebLinkAbout24-11656 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF35258oc� RA
COLLISION REPORT 1591971
ASE# ; 24-11656 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCCO A`GENC'Y 4200 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
COLLISION' 11 - 09 - 2024 1732 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
BLOCK NO.
SW SUNSET BLVD
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET e✓ S 8 W e OAKESDALE AVE SW
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES ✓NO D:2067050120 1 9 30
6 LAST NAME RODRIGUEZ FIRST NAME SOPHIA MIDDLE I t 1 2 31
INITIAL
STREET 10506 55TH AVE S
NEW ADDRESS CITY SEATTLE ST WA ZIP 981782207 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO�/ INTERLOCKYEs E �/ YES ND�/
8❑ DRIVER # STATE WA SEX F MMDCSYY' O6 - 26 - 2008 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY CLASS 1 NATURE OF INJURIES 2
LICENSE, CCL6032 STATE WA VN# JMlBJ2225YO295897 3
10[9� PI ATP rt
11[-j- TRAILER STATE TRAILER ,STATE ROM TO
11 3 5 PLATE# PLATE#
rRLR rRLR 7 3 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN �tpyENIZ GOVT VEHICLE 7 $ 34
13 4 2000 MAZD PROTE SD DAMAGE YES NO " "'"' RS YES NO
REGISTERED OWNER INFO CINDY YANG 1091925TH AVE SW SEATTLE WA 98146 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO NA IQ
IN EFFECT &POLICY# CHARGE 5 36
LecnLLY YES❑NO CITATION# 711
15❑ STM ING
III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES NO �/ D:2064963686
16�
LAST NAME BANHAM FIRST NAME STEVEN MIDDLE J
INITIAL
37
17 STREET'O 50TH ST E CITY FIFE ST, WA ZIP 984242147 4
NEW AbORESS
21 35 ❑
18 CDL ...; IGNITION REQUIRED IGNTION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs NO jNTERLOGKYES NO yES Na
19 DRIVER'S STATE WA SEXI M I D.O.e. 02 09 1983 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H UET 2 SE CLA1 Y NATURE OF INJURIES 40
SS
21 LICENSLATE E C0344C TaTE WA VIN# 5FYH8YU07GC050634 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2016 MAKE IyEyI/ MODEL XCELSIO STYLE $U VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO STEVEN BANHAM3811181ST ST E TACO.WA 98446 D:2064963686 VEHICLE NO.2
SHADE IN DAMAGAREA
2 3
LIABILITY INSURANCE INSURANCECO KING COUNTY RISK MANAGMENT
IN EFFECT &POLICY# t 9TOP
vewaE ❑ CITATION# CHARGE to BOTTOM
EEGnEEv YES N`[
25 a '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
KEVIN PETERSON 12808 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF35258
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11656
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD -F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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.
KEVIN PETERSON 11-09-24 08:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 11/13/2024 4:22:03 PM
BADGE OR ID# 12808 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:37 PM TIME POLICE ARRIVED 5:42 Pfl1
PART B 3oDo-345-,ao(Rtrras) PAGE 27 OF 47
REPORT NO. EF35258 CASE# 24-11656 OF COLLISIONS 11/09/24 17:32
OI;COLLISICiN
NARRATIVE
I was dispatched to a collision on 11/09/24 at 1737 hours at SW Sunset Blvd and Oakesdale Ave SW,
in city Renton, King County WA.
Unit 1 CCL6032 Driver: Sophia I. Rodriguez (DOB 06/26/2008)
Unit 2 C0344C Driver: Steven J. Banham (DOB 02/09/1983)
Unit 2 was stopping at a bus stop on SW Sunset Blvd when the bus had stopped and the door open
to let off a passenger Unit 1 then rear ended Unit 2. Unit 2 had approximately 12 passengers on the
bus. All passengers had departed off the bus prior to my arrival 1 passenger gave her information
incase she was hurt. I attempted to call the passenger got no answer her name and phone number is
Carter Leevonnie (435-479-8712). Unit 1 told me she was heading East on SW Sunset Blvd when
she noticed the bus was stopped to late and could not change lanes. Unit 1 attempted to stop but was
unable to stop and hit the back of the bus.
Both drivers stated no injuries.
I gave all parties an information exchange.
Unit 1's driver Rodriguez was unable to provide proof of insurance upon request and was cited for
driving a motor vehicle with no proof of insurance. Rodriguez was also cited for violating her
instructors permit by not having a licensed driver with her while operating a motor vehicle on the
roadway.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 11/09/2024, 2016 hours at Renton,
WA
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 2
Action Code: STOPPING AT A BUS STOP
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EF35258 CASE# 24-11656 DATE AND TIME i 11/09/24 17:32
OF COLLISION
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