HomeMy WebLinkAbout25-4117 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF90489oc� RA
COLLISION REPORT 1591971
CASE# 25-4117 2
INTERSTATE ❑ CITY STREET FIRE I
RESULTED
STOLENSTATE ROUTE OTHER VEHICLE LOC'AI-A`GENC'Y 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 28
TRIBAL i UNITS 02 STRUCK UTILITY POLE
RESERVATION 2❑3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E IN COLLISION' 05 - 10 - 2025 0819 17 =.= S 8 W❑ OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
116TH AVE SE BLOCK NO. e 15620 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2533984253 30
6 LAST NAME BATEMAN FIRST NAME DAVIS MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 16230114THAVESE CITY; RENTON I ST WA ZIP; 98055 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No✓ INTERLOCKYEs Nd✓ YES NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 03 - 19 - 1985 32
9 ON DUTY STATUS' AIRBAG 3 RESTR 4 EJECT 1 HELMET INJURY 6 NATURE of INJURIES 2❑
USE :CLASS BLOODY NOSE
LICENSE, CGT3356 STATE WA VIN# 1HGCM66503AO42191 3
10 F1 as ATP tt
TRAILER TRAILER
11 3 5 STATE STATE PLATE# PLATE# ROM To
TRLR TRLR. 5 1 33
12 VIN#' VIN#
: FROM TO
13 2 VEH.YEAR2003 MAKE HOND MODEL ACCOR STYLE SD VEHICLETOWED2TOIyS46LIN ajWgYMEYERS VEHICLE✓ m 34
DAMAGE IIII._IIII
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE ElNSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP _
Lrn Lyc ❑ ❑ CHARGE OP MOT VEH W/OUT INSURANCE s t a oorrob z 36
Yes NO CITATION#
15❑
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT�' PEDESTRIAN ✓ D:2063319180
VEHICLE CYCLE OWNER YES NO ✓
16❑
LAST NAME DHAKAL FIRST NAME LOK MIDDLE N
INITIAL
17 F1 STREET ❑
❑ 15620116TH AVE SE CITY RENTON ST, yyq ZIP 98058 4 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES NO (NTERLOC(£YES xz YES No
19❑ LICENSE# STATE SEXI M MD DO.B. 01 13 198 4 39
20❑ ON DUTY STATUS AIRBAG RESTR EJECT HELMET INJURY NATURE OF INJURIES 40USE CLASS ❑
21❑ PLATE# TATE VIN#LICENSE 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
1-1— ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGnEEY YES NCO
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
ST
FAJARILLO 12847 WA0171300
26❑
PART A PAGE 01 OF
3000-348-189(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF90489
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4117
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 CIASS ----�
: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 GLASS
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.
STEVEN FAJARILLO 05-10-25 10:14 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
D.SKELTON 9139 511212025 4:08:23 AM
BADGE OR ID# ; 12847 ORI#s WA0171300 TIME POLICE DISPATCHED 8:19 AM TIME POLICE ARRIVED i 8:19 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF90489 CASE# 25-4117 OF DATE AND r�N + 05/10/25 08:19
O�COLLISION
NARRATIVE
25-4117
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 05-10-2025 1 was working as a police officer in the city of Renton. At approximately 0819 hours I
was dispatched to the report of a collision at 15610 116th Ave SE, City of Renton, County of King,
WA. This incident was captured on my department issued Axon body camera.
According to the notes in the call, a single motor vehicle collided with a pole. There were unknown
injuries. The vehicle was identified as a tan 2003 Honda Accord (WA/CGT3356).
I arrived on scene and contacted the driver and registered owner of the Honda, Davis J Bateman
(DOB: 03-19-1985). 1 confirmed his identity with Department of Licensing photograph. He was the
lone occupant of the vehicle. Davis was evaluated by Renton Fire for airbag deployment and a bloody
nose. Davis denied any other injuries. The following is an account of events according to Davis. He
was travelling northbound on 116th Ave SE when an unknown animal ran across the road. To avoid
hitting the animal he swerved his vehicle to the right. His front passenger quarter panel collided with a
mailbox and a power pole on the east side of the road.
The power pole was not structurally damaged and had some marks on it. The mailbox belonged to
15620 116th Ave SE, Lok N Dhakal (DOB: 01-13-1984). The mailbox pole was broken, and the
mailbox was detached. 1 provided Lok with a case number. I photographed the scene and damage
and uploaded the pictures to Evidence.com.
The Honda was towed by Gene Meyer towing.
Davis did not have valid insurance. I completed a notice of infraction #5A0292725 for no valid proof of
insurance.
According to the facts regarding this case, the Honda swerved to avoid hitting an animal,
subsequently colliding with a mailbox and pole. This was the proximate cause of the collision.
There is no further information available at this time.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Fajarillo #12847 on 05/10/2025 @ 1010 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EF90489 CASE# 25-4117 DATE AND TIME 05/10/2508:19
OF COLLISION
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PAGE 4 OF 4