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Home My WebLink About22-13256 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 22-13256 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 5 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cowsloN 12 - 1-- 2022 0709 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BENSON DR S BLOCK NO. e✓ 1600 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET ❑ S ❑ W❑ 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El �/No D:4252479943 0 7 30 6� LAST NAME LUONG FIRSTNAME NGHIA MIDDLE M 1 2 31 INITIAL STREET ❑ 12166 SE 70TH ST CITy NEWCASTLE ST WA 2jp, 980561205 z= 'NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES z❑ ❑ LICENSE CDN4887 sTArI WWAurN# KNDC3DLC6N5058884 3 10 F91 PI ATE# TRAILER STATE TRAILER STATE 11 4 0 PLATE# PLATE# ROM ro TRLR. TRLR. 5 1 33 12 0 0 VIN#' VIN# >; FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 9 34 13 2 2022 KIA TELLUR DAMAGE vE5 0NO f �AWkkRS vEs❑ No REGISTERED OWNER INFO TRINH NGUYEN 12210 SEPETROVITSKYRD APTK RENTON WA 98058 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 3 4 14 LIABILI INSURANCE INSURANCE CO STATEFARM 509 9060-0O3.47A IN EFFECT &POLICY# 9TOP 15❑ vECEHA"LE 5 36 LLLv res❑NO❑ CITATION# 2A0561208 CHARGE INATTENTION 10 BOTTOM NDING 8 6 MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:4255297674 VEHICLE CYCLE OWNER YES NO �/ 16 a LAST NAME MARTINEZ 77777771 FIRST NAME BRITTANY IN DOLE D IN MIDDLE 17❑ STREET ❑', 3130 TALBOT RD S CITY' RENTON ST WA ZIP 980555023 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCKYES�NOR INTERLOCK YEs❑NOF YEs❑NO❑ 19 LDIIVERI # STATE WA ]SEX IF M .C.B. 03 _ 25 _ 2004 0 39 HELMET {NJURY 1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑ 21❑ LICENSE BDV4558 TAre WA VIN# 5FNYF4H22E6001996 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. VEH YEAR 2014 MAKE HOND MODEL PILOT STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO YES NO REGISTERED OWNER INFO CARLOS CAMARILLO GALVAN 3130 TALBOT RD S RENTON WA 98055 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO NATIONAL GENERAL 2011399942 STOP IN EFFECT VEHICLE CITATION# CHARGE 25❑ i o BOTTOM LEGALLY YES N� J s a 7KLANE S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 10008 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. ED19072 COLLISION REPORT III III III III III 111 1591972 CASE# 22-13256 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) NGUYEN TRAM T (LAST FIRST, ADDRESS&PHONE# D O.B. ' 12210 SE PETROVITSKY RD APT K RENTON WA 980586672 2063541917 SEXi F MMDDYyry 12 - 01 - 1996 PASSENGER Z WITNESS UNIT# 1 SEA 3 AIRBAG 2 RESTR. 4 EJECT 1 HELMET INJURY NATURE OF INJURIES POS. 1 USE 2 CLASS '1 NAME (LAST,FIRST MIDDLE INITIAL) CAMARILLO-MARTINEZ BRIGITTE I ADDRESS&PHONE# DOB 3130 TALBOT RD S RENTON WA 98055 4255722081 SEX IF .M.D vv 09 _ 26 _ 2007 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1 NAME (LAST FIRST,MIDDLE INITIAL) GOUNDAR SWETA P ADDREss PHONE# 3603 SHATTUCK AVE S RENTON WA 98055 4258917215 SEX M D.O•B. 11 _ 03 _ 2004 MMDDYYYY PASSENGER WITNESS UNIT# ! 3 SEAT 1 3 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES ❑ POS. USE CLASS NARRATIVE' Unit 3 was in the right lane of northbound Benson DR S in the 1600 blk stopped for traffic back from a red light at S Puget DR. Unit 2 was stopped directly behind Unit 3. Unit 1 was approaching Units 2 and 3 on northbound Benson DR S in the 1600 blk. For unknown reasons, Unit 1 failed to stop in time and the front end of Unit 1 struck the rear end of Unit 2. The force of this collision sent Unit 2 forward and the front end of Unit 2 struck the rear end of Unit 3. Unit 1 sustained moderate/heavy front-end damage, Unit 2 sustained moderate rear end and front end damage, and Unit 3 sustained light/moderate rear end damage. Driver 1 stated he slid on possible ice but the roadway does not support this statement as it was dry with no substantial ice buildup. Unit 1 towed by Bankers tow, Units 2 and 3 were able to leave under their own power. Driver 1 cited for inattention by not driving with due care and caution recognizing stopped traffic and potentially hazardous roadway conditions which was the proximate cause of the collision. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. K.LANE 12-15-22 12:47 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY E DAT CO.JOHNSON 0505 1212712022 12:40:05 PM BADGE OR ID# 10008 ORI#' ' WA0171300 TIME POLICE DISPATCHED; 7:92 AM TIME POLICE ARRIVED 7:17 AM PART I PAGE IT]OF 4] SUPPLEMENTAL REPORT NO. ED19072 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 22-13256 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:2066411689 OF 7 29 LAST NAME KUMAR FIRST NAME : SHALESHNI MIDDLE INI r:j TIAL STREET 30 NEW AnDRFrtP 3603 SHATTUCK AVE S CITY RENTON ST WA ZIP 980555727 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31 INTERLOCK YEs No zERLOCK YES[:]NO[:] YES N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv', 09 - 13 - 1977 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE AEK2026 TAr Wq VIN# 2T3RF4DV8BW105032 PLATE# 9 9] TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.It VIN.#. 11 0 0 VEH.YEAR2011 MAKE TOYT I MODELRAW STYLE VEHICLE TOWS E T SABLIN TOWED BY anvi vFH1Ci P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO SHALESHNI KUMAR 3603 SHATTUCK AVE S RENTONWA98055 J 9 33 12 � SHADE IN DAMAGED AREA 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 906078707 q"i"Olx IN EFFECT &POLICY# 1 VEHICLE 34 13 2 Lecnuv YES NO❑ CITATION# CHARGE 10 BOTTUM STANDING } 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STRE 16 NEW ETETnnR"� CITY ST ZIP CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE (CLASS 19 ❑ 39 LICENSE VIN# PLATE# rnr 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED 3 4 4 AREA F 43 z LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 VEHICLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LECALLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. K.LANE 12-15-22 12:47 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 10008 O#IL WA0171300 JOHNSON 12127/202 PAGE F OF 4 3000-345-013(R 11118) REPORT NO.! ED19072 CASE# 22-13256 DATE AND TIME 12/15/22 07:09 OF COLLISION ***NOT TO SCALE*** 1600 blk BENSON DR 8 PAGE 4 OF