HomeMy WebLinkAbout26-4733 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 26-4733 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFHIC;I F ❑ LOCAL AOENC 3
HIT&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# ❑
COLLISION 06 - 1-- 2026 1800 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON RD S BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 400 00 FEET MILES e S B W e MAIN AVE S
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2068525045 0 11
30
6� LAST NAME PITTS FIRSTNAME SHALAIN MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 12423 73RD LN S APT.53 CITY SEATTLE ST WA Zjp, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
LICENSE 6812EE STATE WA u N# JM3TB28Y670107083
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. A'RL.R. 1 5 33
12 3 5 VIN#j VIN#'
:: FROM TO
VEH.YEAR ZOO7 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 5 34
13 4 MAID CX-9 UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 6A0326873 OP MOT VEH W/OUT INSURANCE 1 o eorrom
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D.2538201453
16 a
LAST NAME DUSCH FIRST NAME JUSTIN MIDDLE W
INITIAL
17 STREET❑ NEW ADOREss❑' 2804 CEDARAVES CITY RENTON ST WA ZIP 98055 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NOF,/j INTERLOCK YEs❑NOF YES❑NOF,/1
19 D IVEW #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ LICENSE I PLA E# BRJ9559 TATE WA VIN# 19UU61F3XLA002647 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
TOWED BY Gov HI 44
VEH YEAR 2020 MAKE /a C(fR MODEL TLX STYLE $D DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU&PORGY#E CO USAA 0586620007101IN 1 9TOP 5
V'""LE ❑ N J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MAXWELL ATCHISON 13322 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH2O985
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4733
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) WILLIAMS IV ANTHONY L
(LAST FIRST,
ADDRESS&PHONE#
12423 73RD LN S APT 53 SEATTLE WA 98178 SEX M MMDOYyry 09 - 30 - 2002
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 1 PQS, 3 2 4 1 USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY URE OF INJURIES
NAT
❑ ❑ 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.
MAXWELL ATCHISON 06-18-26 01:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.BRAUN 2194 1 7/15/2026 10:52:48 PM
BADGE OR ID# ` 13322 OR]# WA0171300 TIME POLICE DISPATCHED! 6:04 PM TIME POLICE ARRIVED',6:04 PM
PART I PAGE IT]OF 4]
REPORT NO. EH2O985 CASE# 26-4733 OF COLLISION
06/17/26 18:00
OF CbLLI510N
NARRATIVE
CC 26-4733
On 6/17/2026, at 1804, hours I advised Dispatch I saw an argument on the roadside and I was
contacting the involved parties just south of the station on Benson Rd S in the City of Renton, King
County, Washington.
The involved parties advised me this argument was caused by a vehicle collision at approximately the
700 block of Benson Rd S. Both parties relocated to the upper lot at City Hall, 1055 S Grady Way.
Driver 1 (Shalain M. Pitts; 01/06/1981) provided a valid driver's license, expired registration, and was
unable to provide proof of insurance. Driver 2 (Justin W. Dusch; 09/04/1986) provided a valid driver's
license, registration, and insurance.
Pre-Collision
Driver 2 stated that they turned left from Main Ave S and were driving southbound on Benson Rd S in
the #2 lane. The vehicle ahead of them began slowing down causing Driver 2 to slow down as well.
Driver 1 stated they turned left from Main Ave S and were driving southbound on Benson Rd S in the
#1 lane. Driver 1 turned on their left turn signal to enter the #2 lane.
Collision
Driver 2 stated they felt a side impact into their vehicle and observed Unit 1 hit the side of their
vehicle.
Driver 1 stated they began merging into lane 2 when Unit 2 slowed down causing them to collide.
Injuries
Neither driver complained of injuries, and declined aid.
Vehicle Disposition
Unit 2 (WA BRJ9559) had moderate damage to the side of their vehicle. Both their front and rear
passenger side doors appeared dented and had paint scratches. Damage appeared to be more than
$1000.
Unit 1 (WA 681ZEE) had minor damage to the front left quarter panel of their vehicle with paint
scratches in the area. Damage did not appear to be more than $1000.
Proximate Cause
The proximate cause of this collision was Unit 1 failing to yield to Unit 2 while merging into the
southbound #2 lane.
Driver 1 was advised they would receive a citation (6A0326873) via mail for operating a motor vehicle
without insurance.
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 Officer M. Atchison #13322 at 00:58 on 6/17/2026 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EH2O985 CASE# ' 26-4733 DATE AND TIME 06/17/26 18:00
OF COLLISION
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PAGE 4 OF 4