HomeMy WebLinkAbout25-6323 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-6323 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4100 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 07 - 1-- 2025 0601 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR S/SE 172ND BLOCK NO. e✓ 17200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET MILES e S B W e SE 172 ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:5034210444 0 11
30
6❑ LAST NAME LINCOLN FIRSTNAME SHAKIR MIDDLE R 1 1 2 31
INITIAL
STREET ❑, 3607 MILL AVE S CITY RENTON ST WA Zlp' 980555888 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 04 1— 04 — 1979 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 3 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10� P1 aT�S� D14916D sTATI WAurN# 1FT7W26T1KED66006
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR 2019 MAKE FORD MODEL F250 STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
DAMAGE YES NO YES[:] NO✓
13❑ REGISTERED OWNER INFO RAYSOSA 1118 S 36TH ST RENTON WA 98055 VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO STATE FARM 4687557D2647 <1�3 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
E�ALLY YES NO CITATION# 5A0610516 FAIL TO YIELD MOTOR VEHICLEorrom
15❑ STANDING 7 6
MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE
�UNIT 02 ❑ PEDESTRIAN ❑ ❑ YES,/ No D:2065614033
VEHICLE CYCLE OWNER
16 a
LAST NAME JUAREZ GONZALEZ FIRST NAME FRANCISCO MIDDLE IN
INITIAL
17❑ STREET � 201 SW 5TH PL#K105 CITY RENTON ST Wq Zlp 98057 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I No� YES t l NO❑
11
19 D IVE
I INJURY NATURE OF INJURIES 40
20 F1 ON DUTY STATUS AIRBAG 3 RESTR 3 EJECT 1 USE CLASS 7 HEAD PAIN
21❑ LICENSE I C56182V TATe WA vIN1t NMOLS7E7XF1179847
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE FORD MODEL TRANSIT STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES,� NO GENE MEYERS YES NO
REGISTERED OWNER INFO FJ CONSTRUCTION 1171787TH AVE S SEATTLE WA 98178 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY INSURANCE I PORGY#E CO LIBERTY MUTUAL BAS64094113 1 9TOP 5
IN EFFECT
VEHICLE ❑ ,.I—I CITATION# CHARGE io BOTTOM
LEGALLY YES N`LJ
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
SULIASI TAMAIVENA 12788 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EG13556
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6323
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
POS. 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'
On 07/23/2025, at approximately 0601 hours, I was dispatched to an injury accident at BENSON DR
S/SE 172ND ST in the City of Renton, while I was employed as a uniformed Patrol Officer for the City
of Renton, County of King, State of Washington.
Unit#1 advised that he was on the SE 172nd ST in the only lane attempting to take a left turn onto
Benson Dr S. The Driver said that while making his left turn, he did not see Unit#2 vehicle going
southbound on Benson Dr S, which he then hit. Unit#1's vehicle had damage to its front bumper. The
car was still drivable, and the driver had no injuries. Unit#1 did have a stop sign on SE 172nd ST.
The driver was provided with an exchange information form.
Unit#2 advised that he was traveling southbound on Benson Dr S in lane #2 (lane #1 being nearest
to the curb). The driver stated that while he was driving southbound, passing SE 172nd St, Unit#1's
vehicle hit his vehicle from the right passenger side. His vehicle was not drivable due to the heavy
damage it had sustained. Gene Meyers towed the car. The driver was transported to Valley Medical
due to complaints of head pain. An information exchange form was provided to a friend/co-worker of
his who showed up on the scene. Unit#2 did not have any traffic control signs as it had the right of
way.
Unit#1 will be issued a traffic infraction through the mail for failing to yield to vehicles in the right-of-
way (46.61.180.1). The driver is aware of the infraction.
Photos of the vehicles were taken and uploaded as evidence.
This concludes my report.
My Axon camera was on for this call.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SULIASI TAMA/VENA 07-23-25 07:34 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
PHILIP DAVIS 12018 712812025 7:47:33 AM
BADGE OR ID# 1Y788 ORI# j WA0171300 TIME POLICE DISPATCHED', 6:01 AM TIME POLICE ARRIVED 6:09 AM
PART I PAGE IT]OF 3�
REPORT NO.! EG13556 CASE# 25-6323 DATE AND TIME 07/23/25 06:01
OF COLLISION
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