HomeMy WebLinkAbout26-4160 STATE OF II I III 1 IIIllI111IN II II I REPORT NO. EH12985 170
27
COLLISION REP FIT 1591971
SASE 26-4160 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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# ❑
COLLISION.. 05 - 1-— 2026 2312 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON DR S BLOCK NO. e✓ 17200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:6619045987 0 11
30
6� LAST NAME SILVA FIRSTNAME MICHAEL MIDDLE P 1 2 31
INITIAL
STREET ❑, 3240 SE 12TH ST#1035 CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 03 1- 17 - 1987 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 9❑ P1ATE14 CTF0207 STATE WA uN# 1G1RE6E48DU102595
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. TRLR. 5 7 33
12 0 0 VIN#' VIN#'
:: FROM TO
❑ VEH.YEAR 2013 CHEV VOLT SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TLI I� RS GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES No � YES[:] No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 436 1654-A13.47E <�3
4
IN EFFECT &POLICY#❑ LEGA LE CHARGE 36
15 2 VEH" YEs No clTAnoN# 6A0284888 PROH/IMPROPER TURNrrob
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT , ❑✓ ❑ PEDESTRIAN ❑ ❑ D:4256529732
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME ORTIZALPISTA FIRST NAME EMIGDIO MIDDLE
INITIAL
17 STREET Is❑' 601 S 31ST ST CITY' RENTON ST WA ZIP 98055 37
NEW ADDREs
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES t l NoF,/
19 LICENSE# STATE WA SEX M M .C.B. 08 _ 05 _ 1964 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# BLT4573 TATE 41
WA VIN1 1GNSKBEOODR237037 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2013 MAKE CHEV MODEL TAHOE STYLE $V VEHI DAMAGE TO ✓WED NOO BLIN TOWED BY 44
Yr
OV H BANKERS YES No
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 538-5591-E12-47AIN STOP 5
VE"LE ❑ Nu,J CITATION# CHARGE
25 to BOTTOM
LEGALLY YES ' a
OF
NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
THOMPSON 13311 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH12985
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4160
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,FIRS 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 FIRST 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'
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.
MICHAEL THOMPSON 05-30-26 08:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
K.LANE 10008 1 6/17/2026 12:48:15 PM
BADGE OR ID# 13311 ORI#' ; WA0171300 TIME POLICE DISPATCHED 11:12 PM TIME POLICE ARRIVED',11:12 PM
PART I PAGE IT]OF 4]
REPORT NO. EH12985 CASE# 26-4160 OF COLLISION
05/29/26 23:12
OF CbLLI510N
NARRATIVE
26-4160
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.
Assignment
On 05-29-2026 at 2313 hours I was dispatched to a blocking collision with unknown injuries at the
17200 block of Benson DR S.
Statement of Driver 1
Driver 1 stated he was northbound on Benson DR S when he attempted to turn left onto S 172nd ST,
which has a posted no left turn sign. He stated as he was turning left from lane 1, he did not see Unit
2 in lane 2 and was then stuck by Unit 2.
Unit 1 Appeared to meet the damage threshold.
Driver 1 did not have any complaints of injury.
Statement of Driver 2
Driver 2 stated he was driving straight in lane 2 of northbound Benson DR S, when Unit 1 turned in
front of him and he collided with Unit 1.
Unit 2 appeared to meet the damage threshold.
Driver 2 did not have any complaints of injury.
Proximate Cause
Based on the statements of both drivers, and my observations of the collision scene matching the
statements provided I determined Driver 1 to be the proximate cause of the collision by making an
improper left turn, causing Unit 2 to collide with Unit 1.
Disposition
Banker's towing responded and towed both vehicles. I provided both drivers with a business card and
case number.
I completed Sector citation 6AO284888 to be mailed to Driver 1 for making an improper left turn (RCW
46.61.290).
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 Michael A. Thompson #13311 at 1915 on 5/30/2026 in the City of
Renton, King County, Washington.
PAGE 3 OF 4
REPORT NO.! EH12985 CASE# 26-4160 DATE AND TIME 05/29/26 23:12
OF COLLISION
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