HomeMy WebLinkAbout25-6973 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG22245OLCERA
COLLISION REPORT 1591971
CASE# 25-6973 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOO`CODIGENC'Y 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#
DATE OF N E IN eDLLISION' 08 - 11 - 2025 1435 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
BENSON DR S
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e BENSON RD S
2 0 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2533749430 0 1 30
5 LAST NAME KOMISAROVA FIRST NAME SVITLANA MIDDLE 1 1 2 31
INITIAL
STREET ❑ 12 5TH ST NW APT A CITY;AUBURN ST WA I ZIP; 980014036 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES Nt INTERLOCK VEs NO YES NO
8 DRIVER # STATE WA SEXI F MMDDYY' 05 - 25 - 1994 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
LICENSE, CPB0360 STATE WA VIN#; 2T2BK1BA5CC134023 3
10 Fl I PI ATP rt
TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE#
TRLR TRLR. 5 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR ZOI2 MAKE LEXS MODEL RX STYLE VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE g 1 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NSURANCE CO NATIONAL GENERAL 2027662978 3 4
IN EFFECT &POLICY#VEHICLE 4TOP _
YES
srgNOLNG ❑ ❑ SA0625703 CHARGE IMPROPER LANE USAGE o ooTrofi 36
NO CITATION#
15
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES NO �/ D:4257619460
16�
LAST NAME MILLER FIRST NAME KAITLYN MIDDLE' M
INITIAL
17 STREET ❑ 37
1048 REDMOND AVE NE CITY RENTON ST, WA ZIP 980563549
NEW ADDRESS I I I I I I [I
1$❑ IGNITION REQUlREO IGNITION PRESENT MEDICALTRANSPORTED' 38
CDL INTERLOCKYES No INTERLOCK YES NO YES NO
19 DRIVER'S STATE WA SEX F D.O.B. 11 09 2003 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21[ LICEN E LATEIBLB8976 rare WA vIN# 5NPD74LFOJH315423 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 201$ MAKE HYUN MODEL ELANTRA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO ERIC MILLER 15601 SE 157TH ST RENTON WA 98058 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY INSURANCE INSURANCE CO PEMCO CA 1631523
IN EFFECT &POLICY# 9TOP
vewae ❑ ,.I—I CITATION# CHARGE to BOTTOM
L'EGA�LY YES No
25 a e
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. EG22245
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6973
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 CLASS 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.
C.ARNOLD 08-11-25 03:21 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
C.JACOBS 1953 812512025 10:34:29 AM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:39 PM TIME POLICE ARRIVED i 2:42 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG22245 CASE# 25-6973 O OF COLLISION TIME 08/11/25 14:35
NARRATIVE
CC 25-6973
On 8/11/2025 at 1439 hours I was dispatched to a motor vehicle collision at the intersection of
Benson Rd S and Benson Dr S in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was traveling North on Benson Rd S approaching Benson Dr S in the #2 lane.
Driver 1 stated that she was traveling North on Benson Rd S approaching Benson Dr S in the #1 lane
preparing to merge left to enter the #2 lane.
Collision
Driver 2 stated that before the intersection, Unit 1 merged into lane #2 where she was at. Driver 2
stated that the front drivers side bumper of Unit 1 collided with the front passenger side door of Unit 2.
Driver 1 stated that she looked and did not see Unit 2. Driver 1 stated that she merged from the #1
lane to the #2 lane and the front drivers side bumper of Unit 1 collided with the front passenger side
door of Unit 2.
Injuries
None reported.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as
nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety.
Driver 1 was cited per RCW 46.61.140.
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 15:16 on 8/11/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG22245 CASE# 25-6973 DATE AND TIME 08/11/2514:35
OF COLLISION> '
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