HomeMy WebLinkAbout25-2437 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-2437 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 CITY#
CowsloN 03 - 18 - 2025 0934 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BENSON RD S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET e S ❑ W e S PUGET DR
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2066653194 0 11
30
6� LAST NAME DEMENA FIRSTNAME SAMSON MIDDLE T 1 2 31
INITIAL
STREET ❑ 510 STEVENS AVE SW APT N101 CITY RENTON ST WA ZIP 980572370 z
NEW ADDRESS
]❑ 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❑ P1 aT�S� CNt2157 sTArI WAurN# 1FMCU59H68KA71030
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN I TOWED BY GOVT.VEHICLE 5 1 34
13 2 2008 FORD ESCAPE DAMAGE YES fn TO YES[:] H
REGISTERED OWNER INFO SAMSON DEMENA 510 STEVENS AVE SWAPTN101 RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 993104776 3 4
IN EFFECT &POLICY# 9TOP
VEH'CLE
15❑ EC 5 36
LALLv YES❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4256523388
16 2
LAST NAME GARCIA CRUZ FIRST NAME OSCAR MIDDLE N
INITIAL
17❑ STREET ❑', 18307 121ST PL SE CITY' RENTON ST WA ZIP 980586713 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALTRANSFORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES NO❑
19 D IVEW #
{NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE I BFN7870 TAre WA VINtt JHMGK5H57HS011646
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
YEAR 2017 MAKE HOND MODEL FIT STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
VEH
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO LESLIE DOMINGUEZ 1406106TH PL SE EVERETT WA 98208 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 979149348IN STOP 5
vewcLE ❑ ,J� CITATION# CHARGE
25 0( ' a i o BOTTOM
LEGALLY YES N`L J
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. EF84738
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2437
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 FIRST 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 04-03-25 12:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 412212025 3:09:55 PM
BADGE OR ID# 12007 OR]#` WA0171300 TIME POLICE DISPATCHED; 9:36 AM TIME POLICE ARRIVED 9:40 AM
PART I PAGE IT]OF 4�
REPORT NO. EF84738 CASE# 25-2437 OF COLLISION
03/18/25 09:34
OF CbLLI510N
NARRATIVE
On 03/18/2025 at approximately 0924 hours, I was dispatched to a vehicle collision with reports of
injury at the intersection of Benson Rd S and S Puget Dr, within the City Limits of Renton, County of
King, State of Washington.
Upon my arrival, 1 observed heavy mechanism to the involved vehicles with airbag deployment. The
Renton Regional Fire Authority (RRFA) responded to the scene for evaluation. While on scene, 1
collected each of the involved party's driving information and their independent recollection of the
events leading up to the collision.
The driver of Unit#1, identified as Samson Demena, stated that prior to the collision he was traveling
southbound on Benson Rd S approaching the controlled intersection of S Puget Dr in the left turn.
Samson had pulled into the left-turn lane and slowed to yield to traffic for an upcoming left-turn at the
intersection. Samson stated he intended to turn eastbound onto S Puget Dr. Samson stated that his
traffic light turned green, so he made the green light, not seeing Unit#2 traveling in the northbound
lane of Benson Rd S which Unit#1 needed to traverse across. Samson proceeded to make the left
turn across the westbound lanes of travel. While Unit#1 was turning, he noticed Unit#2 approach the
same intersection. Samson stated that both vehicles collided in the intersection causing significant
damage to the front passenger side quarter panel and front bumper of Unit#1.
The driver of Unit#2, identified as Oscar Garcia-Cruz, said he was traveling northbound on Benson
Rd S and approaching the controlled intersection of S Puget Dr in lane 2 of 3. Oscar stated he was
intending to continue north. Oscar stated as he continued going straight ahead through the
intersection, Oscar saw Unit#1 turn in front of his vehicle. Oscar stated he was unable to avoid the
collision and both vehicles collided causing significant damage to the front of Unit#2.
Based on the above statements, 1 was unable to determine who committed the traffic violation due to
the conflicting traffic violations.
* It is importatnt to note that I reviewed Benson Expresso's video cameras but I was unable to see the
traffic collision. The cameras only capatured the grassy area just south of the parking lot.
Both involved vehicles had to be towed due to extensive damage cause. An exchange of information
was provided to all involved parties.
This is an informational report only. No citations were given.
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 by Officer C. Catalan 04/03/2025 Renton, King County, WA.
PAGE 3 OF 4
REPORT NO. EF84738 CASE# 25-2437 DATE AND TIME 03/18/25 09:34
OF COLLISION
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