HomeMy WebLinkAbout24-11829 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-11829 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 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#
cowsloN 11 - 1-- 2024 1513 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
S 180TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e EAST VALLEYHWY
0 3 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES
No ,/ D:2064996336 0 11
30
6� LAST NAME DANG FIRSTNAME CHUM MIDDLE L 1 2 31
INITIAL
STREET ❑ 6764 28TH AVE S UNIT B CITY SEATTLE ST WA 2jp, 981083724 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATE BWS9197 sTATI WAurN#' 1 C4RJFLT4JC214258
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 5 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO 7 $ 34
13 2 2018 JEEP GRAND YES❑ NO✓
REGISTERED OWNER INFO JIN HE 19700 TALBOT RD S RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 438 5094.616.47E
IN EFFECT &POLICY# 9TOP
Ela.e CHARGE 5 36
LvECAIHIv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES NO ,/ D:7144699727
16 a
LAST NAME DEBENEDICTIS FIRST NAME DYLAN MIDDLE M
INITIAL
17❑ STREET ❑', 13269 84TH AVE S CITY SEATTLE ST WA ZIP 981784902 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 LDI IVER # STATE WA SEX M M D.C.B. 04 23 _ 1980 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I D825966 TATe WA vIN1t WIYVOBEY1N4178480
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE MERZ MODEL METRIS STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
L4❑ DAMAGE YESfj
NO,� YES NO
REGISTERED OWNER INFO PSR MECHANICAL LLC PO BOX 27073 SEATTLE WA 98165 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU8 PORGY#E CO GREENWICH INSURANCE RAD943769405 IUQ,
5IN EFFECT'E""LE ❑ ,J� CITATION# CHARGELEGALYYES N`L J25
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. EF40658
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11829
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
PM 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.
C.CATALAN 11-19-24 03:41 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1112812024 2:10:33 PM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 3:16 PM TIME POLICE ARRIVED',3:45 PM
PART I PAGE IT]OF 4�
REPORT NO. EF40658 CASE# 24-11829 OF COLLISION
11/14/24 15:13
OF CbLLI510N
NARRATIVE
On November 14, 2024, at approximately 1513 hours, I was dispatched to a hit and run collision at
the intersection of S 180th St and East Valley Rd, within the City Limits of Renton, County of King,
State of Washington. The driver of unit 2 advised that the other involved vehicle had pulled into 19700
Talbot Rd S. The driver of unit 1 was described as an Asian female wearing a red coat.
Upon my arrival, I contacted both drivers and confirmed there were no complaints of injury requiring
immediate medical response at the time of report. There, I was able to collect each involved party's
information and independent summary of the events leading up to the collision.
The driver of Unit 2 said he was the sole occupant of his vehicle and was traveling eastbound in
about the 400 block of S 43rd St approaching the intersection of Talbot Rd in the right lane. The
driver of Unit 2 stated he was intending to make a right when Unit 1 changed lanes from lane 1 into
lane right turn lane which Unit 2 was occupying. The driver of Unit 2 activated his horn prior to
collision but was ultimately unable to avoid the collision and Unit 1 subsequently collided with Unit 2.
Unit 2 suffered minor damage to the front passenger fender due to the collision.
The driver of Unit 1 also said she was traveling eastbound in about the 400 block of S 43rd St and
approaching the intersection of Talbot RD S in lane 1 of 2. The driver of Unit 1 stated that she needed
to get into the right turn lane. The driver of Unit 1 stated that she never saw Unit 2. The driver of Unit
1 stated that while making the lane change, Unit 1 and Unit 2 collided in right turn lane. She did not
hear the collision, so she proceeded to go home.
Unit 1 sustained moderate damage to the passenger's side bumper, fender, doors, and quarter panel.
Based on the above statements, I determined that the Driver of Unit 1 is the proximate cause for the
cause of collision as the driver violated RCW 46.61.140(1) which states that a vehicle shall be driven
as nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety. The driver made a lane
change into Unit 2's lane of travel which had the right of way and was underway.
An exchange of information was provided to all involved parties.
PAGE 3 OF 4
REPORT NO. EF40658 CASE# ' 24-11829 DATE AND TIME 11/14/24 15:13
OF COLLISION
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PAGE 4 OF 4
