HomeMy WebLinkAbout23-11014 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-11014 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK CONCRETE/JERSEYBARRIER
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 09 - 1-- 2023 2300 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BENSON RD S BLOCK NO. e✓ 1200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 2❑ 20 00 FEET e S B W e 1405 N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2063839599 30
6� LAST NAME FIELDS FIRSTNAME CEDRIC MIDDLE 1 2 31
INITIAL
STREET ❑✓ 339 BURNETT AVE S APT 104 CITY RENTON ST WA ZIP' 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LICIENSE# STATE WA SEX'M I D-MMDDYY' 11 — 19 — 1965 =32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CBM6466 sTArI WAvIN If JH4KC1F5XJC000272
10❑ PI ATE#
----� TRAILER STATE PLAT Eft STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12❑ vIN#' VIN#
2018 ACUR RLX CQ FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
13 2 DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO CEDRIC FIELDS 3398URNETTAVE S APT 104 RENTON WA 98057 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO STATE FARM 5265276-D19.47 3 4
IN EFFECT &POLICY# STOP
VEH'CLE CHARGE 5 36
LECALLv ❑NO❑ CITATION# 1 o BOTTOM
15❑ YES 8 7 6
UNIT U2 VEHICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ oWNFRRTY ❑ DYESMOTO NO OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 5
VE—LE ❑ ,J� CITATION# CHARGE
25 GQ
LEGALLY YES N`L J
s � a
7SI
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12225 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE06435
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11014
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
PM 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.
E.SIMS 09-26-23 12:04 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 101612023 12:36:08 PM
BADGE OR ID# 12225 ORI#' WA0171300 TIME POLICE DISPATCHED! 11:06 PM TIME POLICE ARRIVED',11:08 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EE06435 CASE# 23-11014 OF COLLISION
09/25/23 23:00
OF CbLLI510N
NARRATIVE
Renton Case #23-11014
On 09/25/2023 at approximately 2306 hours, I was dispatched to Benson RD S and NB 1405, in the
City of Renton, King County, Washington, for a report of a non-injury, non-blocking, single vehicle
collision. The reporting party advised there were several bricks in the roadway that caused him to hit
a jersey barrier.
Upon arrival I identified the vehicle as a gray 2018 Acura RLX, bearing WA license plate #CBM6466.
The vehicle sustained heavy damage to the front right bumper and tire. There were several bricks in
the roadway, and I removed them from the road to prevent any other accidents.
I contacted the driver of the vehicle, who I identified via his WADL as Cedric Fields (DOB
11/19/1965). Fields stated he was not injured and told me he was driving northbound in the 1200
block of Benson RD S, when he observed several bricks in the middle of the roadway.
Cedric stated he swerved to avoid hitting the bricks, however he still hit the bricks, and which caused
his vehicle to swerve further and hit the jersey barrier that was on the west side of the roadway.
Cedric was able to slowly move his vehicle to the Renton Police Department, located at 1055 S
Grady Way, which was right down the roadway. There was no damage to the jersey barrier.
I provided Cedric with my business card with the case number on it and he called his insurance
company to have them tow the vehicle. I answered Cedric's questions and cleared the scene. It is
unknown at this time how the bricks ended up in the roadway.
This ends my report.
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 E. Sims on 09/26/2023 at 0001 hours, in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. EE06435 CASE# 23-11014 DATE AND TIME 09/25/23 23:00
OF COLLISION
N NOT TO SCALE
ly
{n
C
N
m
UNIT 1
Jersey Barrier
Bricks
PAGE 4 OF 4