HomeMy WebLinkAbout22-13705 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 22-13705 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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.. 12 - 1-- 2022 0038 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
108TH AVE SE BLOCK NO. e
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 20 1. 00 FEET MILES e S B W e SE 192ND ST
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2067028465 0 81
30
5� LAST NAME SAECHAO FIRSTNAME KAO MIDDLE S 1 1 2 31
INITIAL
STREET El 9608 S 216TH ST CITY KENT ST WA 2jp, 980312043 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMETU E ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 ATNES# B44851 D sTAr WAv N# 5TFBT54177X006234
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2007 TOYT TUNDR DAMAGE YES NO YYES[:] No
REGISTERED OWNER INFO KAOSAECHAO 9608 S 216TH ST KENT WA 980312043 D:2067028465 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 1504812-B27.47B 3 4
IN EFFECT &POLICY# 9TOP
VEHICLe CHARGE 1 5 36
LEGALLv YES No CITATION# SPEED TOO FAST FOR CONDITIONS o eorrom
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254431101
16 a
LAST NAME BLANCHETTE FIRST NAME THOMAS MIDDLE W
INITIAL
17❑ STREET ❑', 8409 S 117TH PL CITY' SEATTLE ST WA ZIP 981784009 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NoF,/
19 DRIVER'S STATE WA SEX M D.C.B. 07 30 _ 1997 39
LICENSE# MMDDYY
WELMET INJURY 6 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 USE CLASS WRIST PAIN ❑
21❑ LICENSE AWR9344 TAre WA VIN# W04G15GV581111273
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE BUIC MODEL REGAL STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO CHERYL BLANCHETTE 8409 S 117THPL SEATTLEWA98178 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 947168393IN IU
STOP
VE""LE CITATION# CHARGE o BOTTOMLEGALLYYES NEI25❑ J
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
LACY SMITH 12613 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED20135
COLLISION REPORT III III III III III 111
1591972 CASE# 22-13705
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,FIRST 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 FIR57 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.
LACY SMITH 12-30-22 12:53 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 12/30/2022 3:43:24 AM
BADGE OR ID# 12613 ORI#' WA0171300 TIME POLICE DISPATCHED 12:40 AM TIME POLICE ARRIVED',12:44 AM
PART I PAGE IT]OF 4�
REPORT NO. ED20135 CASE# 22-13705 OF COLLISION
12/26/22 00:38
OF CbLLI510N
NARRATIVE
On 12/26/2022, 1 was assigned to District 11 as the, 3R11. At approximately 00:46 hours I was
dispatched to a two-vehicle collision located at 108TH AVE SE/SE 192ND ST. This is located in the
city of Renton, the county of King, and the state of Washington.
Per dispatch, the collision was referred to Renton by Kent.
Unit 1-B44851 D
Driver unit 1- KAO SAECHAO
Unit 2- AWR9344
Driver of unit 2- THOMAS BLANCHETTE
I spoke to the driver and sole occupant of unit 1 and identified him as, KAO SAECHAO, by his
colored Washington State driver's license. SAECHAO stated he was travelling south on 108th AVE
SE when he was unable to stop and collided into unit 2. Unit 1 had damaged the front of the vehicle.
I spoke to the driver and sole occupant of unit 2 and identified him as, THOMAS BLANCHETTE, by
his colored Washington State driver's license. BLANCHETTE stated he was at the light when unit 1
ran into the back of his vehicle. Unit 2 had significant damage to the rear of the vehicle.
Renton Fire came to the scene and medically cleared the involved parties. Both parties stated they
were wearing their seatbelts. Both parties drove their vehicles from this scene.
I provided both parties with this case number.
From the statements made on scene and the damage to the vehicles, it appears unit 2 was stopped
at the light when unit 1 was traveling too fast for the conditions and was unable to safely stop. Unit 1
then collided into the back of unit 2.
Unit 1 was sited with R.C.W 46.61.400.1 Speed too fast for conditions.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Name: Officer L. Smith 12613
Date 12/30/2022
Place: Renton, WA.
PAGE 3 OF 4
REPORT NO. ED20135 CASE# 22-13705 DATE AND TIME 12/26/22 00:38
OF COLLISION
UN SE 192ND ST
- Unit 1
This diagram is not to scab
w
us
M
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