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Home My WebLink About23-11016 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 CASE 23-11016 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 03 STRUCK' RETAINING WALL 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 0823 17 ❑-= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BENSON RD S BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e MAIN AVE S 0 1 29 UNIT 01 VEHICLE MOTPI PEDAL-ORCYCLE ElYESA,G/E NHORESHOLD MET PHONE 0 81 30 6� LAST NAME SAWADOGO FIRSTNAME RAHAN MIDDLE A 1 0 1 31 INITIAL STREET ❑ 5010 84TH ST SW APT B42 CITY MUKILTEO ST WA 71p 982752924 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 1 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 1❑ Pi ATNE 14 D507298 STATE WA u N# 1 GBK7C1386F407802 11[-j- TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# IR.. ro TRLR. TRLR. 5 1 33 12 0 0 VIN#j VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE J 9 34 13 3 2006 CHEV C7500 DAMAGE vEs 0NO f �AWkkRS vEs❑ No REGISTERED OWNER INFO RAHAN SAWADOG0501084TH STSWAPTB42 MUKILTEO WA 98275 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14 LIABILI INSURANCE INSURANCE CO SAME. 4 IN EFFECT &POLICY# 9TOP VEHCLE CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# 1 o BOTTOM 15❑ STANDING 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES�/ NO D:5098304127 16 a LAST NAME DIAZ GUTIERREZ FIRST NAME VERONICA MIDDLE N INITIAL 17❑ STREET ❑', 20611THAVEN CITY'ALGONA ST' WA ZIP 980016516 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑ 19 LDI IVEW # STATE WA ]SEX IF M D.C.B. 05 _ 27 1972 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CCX4449 TATE WA VIN# 2FMDK49C386A97216 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. VEH YEAR 2008 MAKE FORD MODEL EDGE STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44 24❑ DAMAGE YES NO BANKERS YES NO REGISTERED OWNER INFO VERONICA DIAZ GUTIERREZ 1319 LAKE YOUNGS WAY SE RENTON WA 98058 VEHICLE NO.2 SHADEDAMAGEbAREA s Cd LIABILITY INSURANCE &POLICY#E CO SAME.IN 9TOP 'E""LE CITATION# CHARGE LEGAL 25 to BOTTOM LY YES Nu ❑ s OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 M.LEVERTON 2517 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE02915 COLLISION REPORT III III III III III 111 1591972 CASE# 23-11016 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) RAZO XEV/AR (IAST FIRST, ADDRESS&PHONE# 206 11TH AVE N ALGONA WA 980016516 5098304127 SEXi F MMDOYyry 05 - OS - 2019 {� SEAT HELMET INJURY NATURE OF INJURIES PASSENGER L, WITNESS❑ UNIT# 2 SOS 9 AIRBAG 2 RESTR. 10 EJECT 1 USE CLASS 7 uNK NAME (LAST,FIRST,MIDDLE INITIAL) CUTSHALL ERIC: ADDRESS&PHONE# D O B 4254307423 SEX U MMDDYyvv PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ POS. USE CLASS NAME (LAST FIRST,MIDDLE INITIAL) SINGH PARMINDER AooREss&PHONE# 2066833980 SEX U 15 _ 1981 M -MDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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. M.LEVERTON 09-26-23 03:06 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 912712023 10:18:43 AM BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 8:23 AM TIME POLICE ARRIVED',8:23 AM PART I PAGE IT]OF 5� REPORT NO. EE02915 CASE# 23-11016 OF COLLISION 09/26/23 08:23 OF CbLLI510N NARRATIVE blue sedan/3 blk suv/2 stopped wht box brakes rear RTF Within the city limits of Renton/King/WA I responded to a 2 car 1 box truck crash at the intersection of Benson Rd S at Main Ave S. I contacted the driver of unit 2 who told me she was stopped for the red light-NB Benson Rd at Main Ave S when she was hit from behind by a box truck. She was shoved into unit 3. She did not complain of injury but had her young passenger checked by Renton Fire. Damages required a tow truck. I contacted the driver of unit 3 who told me she was stopped in traffic at a red light-NB Benson Rd S at Main Ave S when she was hit from behind and wasnt sure how it all happened. She was did not complain of injury and damages did require a tow truck. The driver of unit 1 said he lost his brakes while NB on Benson Rd S. When he was unable to stop he forced his truck into the retention wall between Benson and 1-405. It was obvious how long he had attempted to stop his truck from the marks on the wall. He was still over the curb and into the wall at the time of impact hitting unit 2 and pushing them into unit 3. He did not complain of injury and damages required a tow truck. Information/insurance only I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. M.Leverton/2517 City of Renton/King/Wa 9/26/2023 PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EE02915 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 23-11016 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GI PLACARD IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE UNIT# 3 �✓ � PEDESTRIAN YES NO 5 VEHICLE CYCLE OWNER ✓ D:2063750511 OF 8 29 LAST NAME GORDON FIRST NAME BRANDY MIDDLE' ',, K] r:j INITIAL STREET 30 NEW AnDRFSP' 12020 SE 219TH CT CITY KENT ST WA ZIP 980313902 6 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TAN5PORTED 1 1 2 31 INTERLOCK YEs No NTERLOCK YES[:]NO[:] YES N DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 09 - 04 - 1978 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET I INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE AAD6009 [TAT WA VIN# YV1AS982081056884 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 0 0 VEH.YEAR2008 MAKE VOLV MODELS80 STYLE VEHICLE TOWS E T SABLI anvi vFH1G P FROM TO DAMAGE YES✓NO YES NO ✓ 33 12 REGISTERED OWNER INFOBRANDY GORDON 12020 SE 219TH CT KENT WA 98031 J 9 SHADE IN DAMAGED AREA 7 j LIABILITY I EFFEYINSURANCE INSURANCE CO SAME. FROM TO 1 i"01 m 34 IN EFFECT &POLICY# 13 ❑ VEHICLE ❑ CITATION# CHARGE 0 BOTTOM VEGALLYHICLE YES NO STANDING S} 7 14 ❑ UNIT Tr Vd IRE O CYDCLE 1:1OWNERRTY YES AGE NOHRESHOLD MET PHONE ❑ 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ ET 16 STRETRE "F ' CITY ST ZIP NEW CDL IGNITION REdUiRED IGNITION PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YES NO YEs NO El 17 37 LICENSE#RIVERS 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 AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEHIcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM C=ESTANDING 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. X LEVERTON 09-26-23 03:06 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OI BADGE 2517 O#I',WA0171300 JACOBS 912712023 PAGE F41 OF F 3000-345-013(R 11118) REPORT NO. EE02915 CASE# 23-11018 DATE AND TIME 08/26/230823