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HomeMy WebLinkAbout25-7138 T �Fi II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG19772POLICER� COLLISION REPORT 1591971 ❑ FIRE ❑ �/�$E$ 25-7138 2 6 6 INTERSTATE CITY STREET ✓ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ VEHICLE ❑ LOCAL AGENCY 3 HIT&RUN C©DIN6 COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 03 STRUCK ❑ RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E eDL�Is[oN' 08 - 15 - 2025 1702 17 =.= S 8 W❑ INF 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BENSON RD S BLOCK NO. e 1000 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 10001.1 MILES FEET e✓ S 8✓ W e S GRADYWAY 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2065018764 0 1 30 6 LAST NAME ODOM FIRST NAME JOSEPH MIDDLE D 1 1 2 31 INITIAL STREET ❑ 1133 EAGLE LN S APT 12 CITY; RENTON ST I WA Zlp; 98055 2 NEW ADDRESS 7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES ND✓ INTERLOCK YEs N©✓ YES NO✓ 8 DCIENSE# STATE WA SE XI M MMDDYY' 04 - 20 - 1991 1 2 32 9 ON DUTY STATUS' AIRBAG 3 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 NATURE of INJURIES 2❑ 10 LI ENSE' D54199E STATE WA V # 1FTZR45E07PA68499 3 11 3 5 TRAILER STATE TRAILER STATE PLATE# PLATE# FROM To TRLR zRLR. 1 5 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR 2007 MAKE FORD MODEL RANGE STYLE PK VEHICLE TOWED 2 TO fIBLIN TOWEDBY GOVT VEHICLE g 1 34 13 DAMAGE YES NO II_II YESII_I) NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO PROGRESSIVE 984614238 3 4 IN EFFECT &POLICY# 9TOP Lrn Lyc ❑ ❑ 5A0624924 CHARGE SPEED TOO FAST FOR CONDITIONS t a oorrob z 36 Yes NO CITATION# 15❑ MOTCYR ✓ PEDAL- PEDESTRIAN1:1 PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:9108498626 16� LAST NAME BURGESS FIRST NAME ANGEL MIDDLE C INITIAL STREET ❑ 17 ❑ 702 S 84TH ST CITY TACOMA ST, WA ZIP 98444 q 37 NEW ADORE SS 18❑ CDL IGNITION REQUIRED (GNITION PRESENT MEDICAL TRANSPORTED. 38 INTERLOCKYEs No✓ INTERLOCK YES ND✓ YES Nfl✓ 19 DRIVER'S STATE WA SEX F I D,02 F,, 10 1970 � 39 LICENSE# MMDDYY — 20❑ ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40 USE CLASS TRANSPORTED BY FIRE 21 LICENSE LATE# CRJ5301 rare WA vIN# JN1DFOBBlRM733620 41 22❑ PLATE# STATE PLATE# STATE 42 23 TRLR r RLR 43 UIN#. 'IN# VEH.YEAR 2024 MAKE HISS MODEL ARIYA STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24❑ DAMAGE YES ✓ NO NO✓ REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO.2 SHADFY DAMAGED AREA 3 4 LIABILITY INSURANCE INSURANCE CO USAA 024359283C IN EFFECT &POLICY# 9TOP vewaE ❑ ,J—I CITATION CHARGE t080TTOM EEGnEEY YES N 25 e OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 MATTHEW TRAINO 12811 WA0171300 ❑ PART A PAGE 01 OF 3000-345-189(R 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG19772 COLLISION REPORT III III III III III 111 1591972 CASE# 25-7138 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) ODOM SIA L ADDRESS&PHONE# 1133 EAGLE LN S APT 12 RENTON WA 98055 SEXi F MMDDD B. 12 - 07 - 2016 PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES z E 1 POS. 3 3 4 1 USE 2 CLASS 1 ----� :NAME Lgsr EIRST,MIDDLE INITIAL) MCCOY AAVON M ADDRESS R PHONE# MMDDY Y TACOMA SEX' U D p'e•YY 03 _ 26 _ 2022 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER a WITNESS UNIT# 2 POS. 7 AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----� NAME MIDDLE INITIAL) GILLS KING JOSIAH I (LAST,FIRST, ADDRESS&PHONE# TACOMA SEX U D.p.B. 06 _ 28 _ 2015 MMDDYYYY PASSENGER WITNESS UNIT# 2 SEAT 9 AIRBAG 6 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES a � POS. USE CLASS RE 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 TRAINO 08-16-25 10:20 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.KORDEL 9676 8/17/2025 9:39:28 AM BADGE OR ID# 12811 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:07 PM TIME POLICE ARRIVED i 5:15 PM PART B 3 Do-3mx-attar gt 1Mffp PAGE F2 --]OF F STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG19772 COLLISION REPORT III III III III III 111 1591972 CASE# 25-7138 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) GRUSHKE ANDREYI ADDRESS&PHONE# D� 17907 116TH AVE SE RENTON WA 980586567 4256598169 SEXi M MMDDYYYY B. 01 — 30 — 2002 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ] 3 POS. 3 6 4 1 USE 2 CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS R PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES POS. USE CLASS ----� :NAME :.(L4ST,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. MATTHEW TRAINO 08-16-25 10:20 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.KORDEL 9676 8/17/2025 9:39:28 AM BADGE OR ID# 12811 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:07 PM TIME POLICE ARRIVED i 5:15 PM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 0 OF F6 REPORT NO. EG19772 CASE# 25-7138 OF COLLISION r�N + 08/15/25 17:02 O�COLL1510N NARRATIVE On 08/15/2025 at approximately 1707 hours I was dispatched to a reported collision in the 1000 block of Benson RD S, within the City of Renton, County of King, State of Washington. The following was recorded on my department issued body camera (BWC). Statements and events have been summarized for clarity, see my full BWC footage for further details. Unit 1 is a 2007 Ford Ranger (WA Plate D54199E), which was driven by Joseph D. Odom (04/20/1991, WADOL). Upon contact, Odom stated that he was driving southbound in the 1000 block of Benson RD S, when he lost control of the Ranger in the rain. Odom's daughter Sia L. Odom (12/07/2016) was in the front right passenger seat. Neither reported any injuries. Unit 2 is a 2024 Nissan Ariya (WA Plate CRJ5301), which was driven by Angel C. Burgess (11/10/1970), WADOL). Upon contact, Burgess stated that she was driving northbound in the 1000 block of Benson RD S, when the Ford Ranger swerved in front of her vehicle. She attempted to avoid the collision, when her vehicle collided with another vehicle that she could not remember. Burgess's grandchildren were passengers in the vehicle, identified as King Josiah 1. Gillis (06/28/2015), and Aa'jon M. McCoy (03/26/2022). Burgess reported severe pain and was transported by Renton Fire to an unspecified hospital for treatment. There were no reported injuries to the juveniles. Unit 3 is a 2019 Kia Forte (WA Plate BVX0675), which was driven by Daisey R. Petersen (08/26/2004, WADOL). Upon contact, Petersen stated that she was driving southbound in the 1000 block of Benson RD S, when she suddenly saw the Nissan Ariya cross into her lane. Petersen said that she was unable to remember any further details. Andrey I. Grushke (01/30/2002, WADOL) was in the front right passenger seat. Petersen reported that she is pregnant and that she was experiencing chest pain. She was examined and released by Renton aid units on scene. Grushke reported on injuries. All three involved vehicles sustained significant damage to the front bumper area of the vehicles, as well as multiple airbag deployments. At the time of the collision, it was daylight, with overcast, rainy weather, and wet roads. Based on Odom's statement, as well as the statements of Burgess and Petersen, the proximate cause of the collision was Odom's loss of control of his vehicle. Odom was issued a notice of infraction for Speed to Fast for Conditions under RCW 46.61.400. The infraction was explained to Odom, who was advised they would be receiving the infraction via mail, he stated that he understood. N/F PAGE 4 OF 6 SUPPLEMENTAL REPORT No. EG19772 POLICE TRAFFIC 1 1 8 27 µ ^'� COLLISION REPORT CASE# 25-7138 t113197 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACARD GWUR NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE UNIT# 3 PEDESTRIAN ❑', YE NO No D:2068543404 5 VEHICLE CYCLE OWNER 0 1 29 LAST NAME PETERSEN FIRST NAME DAISY MIDDLE; R INITIAL STREET 30 s 17907 116TH AVE SE CITY RENTON ST WA ZIP 980586567 6 [6 NEWADORF 1 1 2 31 CDL IGNITION REOUIREb I{iNi71ON :: PRESENT MEDICAL INTERLOCK YES NO ;INTERLOCK YES _ YES N,..� L DRIVERS VyDL6NT7D71SB WA SEX F D,O. 08 7 LICENSE' MMDDvvv - 26 - 2004 HELMET INJURY NATURE OF INJURIES ON DUTY STATUS AIRBAG 6 RESTR. 4 EJECT 1 USE 2 CLASS 7 CHESTPAIN LICENSE BVX0675 TAT WA VIN 3KPF24ADXKE049908 PLATE# 9 9] TRAILER TRAILER L PLATE# STATE PLATE# STATE 0 10 ❑ TRLR TRLR VIN.# VIN#. 11 3 5 VEH.YEAR2019 MAKE KIA MODELFORTE STYLE SD VEHICLE TOWE E T ABLIN TOWED BY GovT vEHICI F ROM To DAMAGE YES NO ✓ YES NO REGISTERED OWNER INFOALYSSA PETERSEN 17907116TH AVE SE RENTON WA 98058 SHADE IN DAMAGED AREA 5 1 33 12 a 4 FROM TO INSURANCE CO LIABILITY INSURANCE TRAVELERS 6133767222031 5 ❑ IN EFFECT O &POLICY# 5Tt7P m 34 4 1a 3oTraM 13 vewcEe YES[:] NO❑ CITATION# CHARGE Ecauv s rnNolNc MOTOR PEDAL_ ' 1:1PROPERTY : DAMAGE THRESHOLD MET PHONE 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 36 15 LAST NAME FIRST NAME NIT AL 16 ❑ STREET �' CITY ST' ZIP n>EW ADDRFSS CDL IGNITION RE6UIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YES[]No INTERLOCK YEs Net YES No ❑ 17 q 37 LICENSE#RIVER'SSTATE MD.r3b.B 18 ❑ HELMET INJURY ❑ ' NATURE OP INJURIES 38 ON DUTY STATUS' AIRBAG RESTR. EJECT USE CLASS. 19 ❑ LICENSE TAT uN# 39 PLATE# 20 TRAILER I TRAILER 40 PLATE# STATE PLATE# STATE ❑ 21 ❑ ❑ 41 TRLR TRLR VIN# VIN#Y 42 22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T ABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAM ACED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT &POLICY# 7 _ » _.__ y. 44 vT ALL ❑ ❑ CITATION# CHARGE 70 BOTiC?M 24 I..EGALLY YES NO STANDING 3 G I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. MATTHEW TRAINO 08-16-25 10:20 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 BADGE OR ID# 12811 O#RI WA0171300 APPROVED BY 8117/2025 PAGE�OF 3000-345-013(R 11/18) REPORT NO. EG 19772 CASE# 25-7138 DATE AND TIME 08/15/25 17:02 OF COLLISION t_ F \t; U � "rw �y}o}gtit Z,u } r. t 9` o PAGE 6 OF e