HomeMy WebLinkAbout25-3999 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF89271OLCERA
COLLISION REPORT 1591971
CASE# 25-3999 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 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#
eDCL s on' 05 - 06 - 2025 0857 17 =.= S 8 W e IN OF e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
BENSON DR S
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e S2ISTST
0 1 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2062949333 0 6 30
6 LAST NAME SAFI FIRST NAME NELOFAR MIDDLE t 1 2 31
INITIAL
STREET ] 12210 SE PETROVITSKYRD APT B104 CITY; RENTON ST WA ZIP; 98058 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERON KY ES NO YES No
8 DRIVER # STATE WA SEXI F MMDDYY' 05 - 25 - 2005 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY',1 [NATURE of INJURIES 2
10 PlATLAS#'' srATe VIN# 4T1BK1FK1CU511713 3
TRAI STATE TRAILER LE STATE
11 3 5 ,LATE# PLATE# FROM To
TRLR TRLR. 5 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2012 MAKE TOYT MODEL CARRY STYLE VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE g 1 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO GREGORY KOI(OROWSKI 907 N 82ND ST SEATTLE WA 98103 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ INSURANCE CO 3 4
11
IN EFFECT &POLICY# CDQV""' CHARGE 5 36
LE,,ALLY YES❑NO❑ CITATION#
15❑ STM ING s 7 e
11
AM
PROPERTY
MOTOR PEDAL- PEDESTRIAN Y D OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ nWNRR vEs� E
/ THR HONo D:2533848836
16�
LAST NAME SCOTT FIRST NAME SHERECE MIDDLE N
INITIAL
17 F1 STREET ❑❑ 37 4007 S 172ND ST CITY' SEATAC ST, WA ZIP 981883630
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES Na INTERLOCK YES R NO YES No
19 DRIVER'S ' STATE WA SEX F I D.O.B. 08 29 1979 � 39
LICENSE# MMDDYY
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT '1 7 ❑
USE CLASS NECK AND BACK PAIN
LATEI21 LICEN E CSH9606 rare WA vIN# KL77LHEPXSC139853 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2025 MAKE CHEV MODEL TRAX STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO NO
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE[Z INSURANCE CO PROGRESSIVE 969896322
IN EFFECT &POLICY# t STOP
VewaS L'—LY YES❑ N,.I—J I CITATION# CHARGE to BOTTOM
`.L
25 s s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF89271
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3999
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME SAFI WAZHMA N
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D�
12210 SE PETROVITSKY RD APT B RENTON WA 980586656 SEXi F MMDD,O B. 01 — 10 — 2001
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1 POS. 3 2 4 1 USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS R PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY: NATURE OF INJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
C.ARNOLD 05-06-25 10:40 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 5/7/2025 9:16:54 AM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 8:58 AM TIME POLICE ARRIVED i 9:03 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF89271 CASE# 25-3999 OF DATE AND r�N + 05/06/25 08:57
O�COLLISION
NARRATIVE
CC 25-3999
On 5/6/2025 at 0858 hours I was dispatched to a motor vehicle collision at the intersection of Benson
Dr S and S 21st St in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was traveling North in the #2 lane of Benson Dr S crossing the intersection of
S 21 st St in heavy traffic.
Driver 1 stated that she was behind Unit 2 in the #2 lane of Benson Dr S approaching S 21 st St.
Collision
Driver 2 stated that she braked for traffic ahead of her, and when doing so the front bumper of Unit 1
collided with the rear bumper of Unit 2.
Driver 1 stated that Unit 2 began to brake for traffic, and she did not have time or distance to slow
down to avoid a collision. Driver 1 stated that the front bumper of Unit 1 collided with the rear bumper
of Unit 2.
Injuries
Driver 2 complained of minor neck/back pain but refused medical treatment at the scene. No other
injuries reported.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because she was following Unit 2
more closely than was reasonable and prudent, resulting in her not being able to stop in time to avoid
a collision. Driver 1 also advised that she does not have insurance for her vehicle.
Driver 1 was cited per RCW 46.61.145 and RCW 46.30.020
1 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 C. Arnold #12509 at 09:31 on 5/6/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. E F89271 CASE# 25-3999 DATE AND TIME 05/06/25 08:57
OF COLLISION
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