HomeMy WebLinkAbout25-4017 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF90264oc� RA
COLLISION REPORT 1591971
CASE# 25-4017 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 2007 17 =.= S 8 W e OF e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TALBOT RD S BLOCK NO. e 900 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
S A �. FEET e S 8 W e I-405
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2064886504 0 4 30
5 LAST NAME KITH FIRST NAME STEVEN MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 10921 SE 226TH ST CITY; KENT ST' WA ZIP; 980312702 2
NEW ADDRESS
7 COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 3
INTERLOCKYEs ✓NO INTERLOCKYES NO✓ YES F NO✓
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 12 — 18 — 1981 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 NATURE of INJURIES 2=
10 LI ENSE' ATJ6024 STATE WA V # 1HGCR3F88FA010393 3
TRAI STATE TRAILER LE STATE
11 3 5 ,LATE# PLATE# FROM To
TRLR zRLR. 3 5 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2015 MAKE HOND MODEL ACCOR STYLE 4D VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 3 $ 34
13� DAMAGE YES�NO ✓� YES❑ NO✓
REGISTERED OWNER INFO SUYTEANG LY 10921 SE 226TH ST KENT WA 98031 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 14 STATE FARM 034680t-A29-47G
IN EFFECT &POLICY#VEn" CHARGE 36
Lec LY YES❑NO❑ CITATION# <14,
15 STANDING
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:4259705642
16�
LAST NAME PATU FIRST NAME DAVYN MIDDLE' D
INITIAL
17 F1 STREET ❑❑ 11814 SE 191ST ST CITY' RENTON ST, WA ZIP 980587204 4 37
NEW ADDRESS
1$❑ IGNITION REQUIREfl fGNfTION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCK YEs NO✓ INTERLOCK YES NO
FcDL ✓ YES NO✓
19 DRIVER'S STATE WA SEX M D.C.a. 02 06 2002 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 R USE 2 CLASSY 1 NATURE OF INJURIES 40
21 LICENSE
LATE# D65002F rarE WA vIN# 1FT6W5L7XRWG19066 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2024 MAKE FORD MODEL F150 STYLE TR VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO BUILD 360 CONSTRUCTION LLC 746 INDUSTRYDR TUKWILA WA 98188 D:2068499081 VEHICLE NO.2
SHADE IN DAMAGEAREA
2 3
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 00694850.0
IN EFFECT &POLICY# 9TOP
w1— CHARGE
LvEeALY YES❑ NL] CITATION 11
to BOTTOM
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MATTHEW MOLLENBERG 13031 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF90264
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4017
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 GLASS 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.
MATTHEW MOLLENBERG 05-07-25 01:30 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 5/10/2025 7:51:12 PM
BADGE OR ID# j 13031 ORI# WA0171300 TIME POLICE DISPATCHED 1 8:10 pry] TIME POLICE ARRIVED i 8:43 PN1
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF F5
REPORT NO. EF90264 CASE# 25-4017 OF DATE AND r�N + 05/06/25 20:07
O�COLLISION
NARRATIVE
25-4017
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 05-06-2025 at approximately 2010 hours I was dispatched an accident located at S Puget Dr and
Benson Dr S. Dispatch advised of a moving two vehicle collision located at the intersection of S
Puget Dr/Benson Dr S. Dispatch advised that Unit Number 1, was a gray Honda Civic bearing
WA/ATJ6024. Unit 2 was a black Ford F-150 bearing WA/D65002F.
Upon my arrival, I found:
There was a two-vehicle collision, both vehicles were located at the above stated locations off the
roadway. I was advised that the collision had taken place exiting 1-405 into the intersection of the off
ramp and Talbot Rd S. I observed that Unit 1 had damage to the driver side front bumper and the
bumper was partially disconnected from the vehicle. Unit 2 had minor damages to the rear passenger
side wheel.
The operator of unit 1 made the following statements:
The operator of Unit 1 was identified by Washington State Driver's License as Steven N. Kith (DOB
12-18-1981). Steven stated he was in the number 2 lane that turns from the off ramp of 1-405 onto
southbound Talbot Rd S. When he was turning in the intersection he merged into the number 1 lane,
striking Unit 2 accidentally who was occupying lane 1. He advised that he was the proximate cause of
the collision based on him merging into the lane of Unit 2.
The operator of Unit 2 made the following statements:
The operator of vehicle 2 was identified by Washington State Driver's License as Davyn D. Patu
(DOB 02-06-2002). Davyn stated he was driving in his lane of travel which was the number one lane
exiting 1-405 onto southbound Talbot Rd S when the operator of Unit 1 struck his vehicle on the rear
passenger side.
Investigation of the collision scene found:
Both vehicles were traveling through the intersection turning southbound on Talbot Rd S from 1-405
within their lanes of travel. The operator of Unit 1 merged into the lane occupied by Unit 2 while
turning through the intersection which was the proximate cause of the collision.
Officer conclusion:
Both drivers provided valid and current Identification, Registration, and Insurance. An exchange of
information was provided for both drivers, they were also provided with their case #25-4017.
1 declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by M. Mollenberg 13031 on 05-07-2025 at 0130 hours in Renton,
WA.
**** AUTO-POPULATED SECTION ****
PAGE 3 OF 5
REPORT NO. EF90264 CASE# 25-4017 OF DATE AND r�N + 05/06/25 20:07
O�COLLISION
NARRATIVE
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Location Character: INTERSECTION
**** END OF AUTO-POPULATED SECTION **
PAGE 4 OF 5
REPORT NO. E F90264 CASE# 25-4017 DATE AND TIME 05/06/25 20:07
OF COLLISION
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