HomeMy WebLinkAbout23-10574 ITFF' "POLCERA II I !�� I III I III I IIII III II I . B 27c
COLLISION REP FIT 1591971
CASE 23-10574 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 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#
cowsloN 09 - 1-- 2023 1855 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S GRADY WAY BLOCK NO. e ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SHATTUCKAVES
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:6187723321 0 11
30
6� LAST NAME BUENSUCESO FIRSTNAME SARAH MIDDLE A 1 2 31
INITIAL
STREET ❑ 409 WHITWORTH AVE S CITY RENTON ST WA ZIP 98055 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'F MID
IF B 12 1- 18 - 1993 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ P1 ATE 14 CHD4573 STATE WA v N# 4T4BF1FK6DR334684
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 1 5 33
12 3 5 vIN#' VIN#
>;. FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 3 TOWED BY GOVT.VEHICLE 34
13 2013 TOYT CAMRY SD DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO SARAH BUENSUCESO 409 WHITWORTH AVE S RENTON WA 98055 D:6187723321 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE INSURANCE 14� NS MAIN ST AMERICA 01J71 10S 3
IN EFFECT &POLICY# 9TOP
vewcLe CHARGE 1 5 36
LEIALLv YEs No CITATION# 3A0223572 FAIL TO OBEY TRAFFIC CONTROL o eorrom
15❑ NDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2065506986
LAST NAME KIMBREL FIRST NAME ZACHARY MIDDLE M
INITIAL
17 STREET❑ NEW ADDRESS❑' 19243 SE 268TH ST CITY COVINGTON ST WA ZIP 98042 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES t l NOF,/
19 LICENSE# STATE WA SEX U M.C.B. 10 _ 24 1983 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# C46520S TATE 41
WA vIN# 1C6SRFBT3KN888555 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE DODG MODEL RAM1500 STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ZACHARY KIMBREL 19243 SE 268TH ST COVINGTON WA 98042 D:2065506986 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#ECO STATE FARM 210-7758-EO9IN IGQI
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s 7 6
7TRADER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 4553 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED98989
COLLISION REPORT III III III III III 111
1591972 CASE# 23-10574
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'
23-10574
On 09/13/2023 at approximately 1855 hours, I was stopped for a red traffic signal facing northbound
on Shattuck AVE S at S Grady Way, in the City of Renton, County of King.
I saw Unit 1 driving SB on Shattuck AVE S crossing S Grady Way. I then saw Unit Two driving EB in
the curb lane as it approached the intersection it became apparent the Unit 1 and Unit 2 were going
to collide. Unit 2 applied its brakes aggressively causing his vehicle to skid but was not able to avoid
colliding with Unit 1.
Both vehicles pulled over and the driver of Unit 1 who was identified with a WA State license as
Buensuecso exited her vehicle and stated she was distracted and didn't see the red light. The driver
of Unit 2 was identified as Kimbrel with a WA State license. They were both wearing their seatbelt
and neither had any injuries.
Kimbrel asked if Buensuecso would be cited for causing the collision and I confirmed she would be
cited.
I told Buensuecso she would receive a citation in the mail for the violation.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.TRADER 09-14-23 11:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 911412023 11:29:51 PM
BADGE OR ID# 4553 OR]#' WA0171300 TIME POLICE DISPATCHED 6:55 PM TIME POLICE ARRIVED'6:55 PM
PART I PAGE IT]OF 3�
REPORT NO. ED98989 CASE# ' 23-10574 DATE AND TIME 09/13/23 18:55
OF COLLISION
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