HomeMy WebLinkAbout23-3216 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-3216 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 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# ❑
cawsloN 03 - 1-- 2023 0535 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON RD S BLOCK NO. e✓ 16500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2062516656 1 4 30
6❑ LAST NAME YACKEL FIRSTNAME KELLY MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 1850 GRANT AVE S APT Cl CITy RENTON ST WA Zjp, 980553621 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'F MID
.O B 09 — 03 — 1968 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BPH6127 sTArI WAvIN# 3KPFL4A73HE131978
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 1 5 33
12 0 0 VIN#j VIN#
FROM
34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE
13 2017 KIA FORTE 4D DAMAGE YES No �MEYER TOWING YES[:] No✓
REGISTERED OWNER INFO NONECARMAX BUSINESS SERVICES P.O.BOX440609 KENNESAW GA 30160 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14❑ LIABILI INSURANCE INSURANCE CO GEICO 4466-84.54.37
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING 7 6
UNIT VE IMOTOOR CYCLE ❑ PEDESTRIAN ❑ OWNER
❑PEDAL- DYES✓ H OLD MET PHONE
16❑
LAST NAME NONE FIRST NAME MIDDLE
INITIAL
STREET CITY SEATTLE ST ZIP 4
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NOR INTERLOCK YEs❑NOF YEs❑NO❑
19 LLIICENS RIVER# STATE SEX U MMDDYY —�_ ❑ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
❑ILICENSE 21❑ PLA E# BRH9467 TAre 41
WA VIN# 2T2BGMCA2KC036597 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2019 MAKE LEXS MODEL RX450H STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YESfj
NO✓ YES NO✓
REGISTERED OWNER INFO BRIAN NHAM 1931 S ORCAS ST SEATTLE WA 98108 D:2068773488 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IGD
VEHICLE ❑ ,.I—I CITATION# CHARGE
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JESSE VANDERHOEK 11631 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. ED43929
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3216
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'
Vehicle #1 was traveling southbound in the 16500 block of Benson Rd S. Vehicle #2 was unoccupied
and legally parked facing south on the shoulder of the west side of the roadway in the 16500 block of
Benson Rd S. The driver of vehicle #1 advised me she was pulling over to the right shoulder of the
roadway so she could use her cell phone, but while doing so she did not see the vehicle parked on
the shoulder in front of her, causing the front end of her vehicle to collide with the rear end of the
parked vehicle, which was vehicle #2. 1 was unable to make contact with the registered owner of
vehicle #2 so I left a business card on their driver's door handle. Due to the totality of the
circumstances, it appeared the driver of vehicle #1 caused this collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JESSE VANDERHOEK 03-20-23 06:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 3/20/2023 1:00:26 PM
BADGE OR ID# 11631 OR]# i WA0171300 TIME POLICE DISPATCHED; 5:39 AM TIME POLICE ARRIVED]5:45 AM
FART I PAGE IT]OF 3�
REPORT NO. ED43929 CASE# 23-3216 DATE AND TIME 03/20/23 05:35
OF COLLISION
0 N
Not to scale
.,(----Vehicle #
V.I
xy..
a< ----Vehicle #1
'
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