HomeMy WebLinkAbout24-1979 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
SAS 24-1979 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 5 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CtLLISION' 02 - 1-- 2024 0914 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 V EAGLE RIDGE DR
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:7275142685 0 11
30
6� LAST NAME BARISO FIRSTNAME JOSEPH MIDDLE C 1 2 31
INITIAL
STREET ❑, 1231 EAGLE LN S APT 10 CITy RENTON ST WA ZIP' 980554417 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ DRIVERS
# STATE WA SEX'M I D-MIDI Y' 04 - 29 - 1993 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES z❑
3
10� Pi aT�S� A6579263 sTATe WAvIN# 3HGGK5H6XJM715933
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 2 2018 HOND FIT HB DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO KAITLYN BECKMAN 1231 EAGLE LN S APT 10 RENTON WA 980554417 D:9163006018 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO PROGRESSIVE 948992737 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2066395863
16 a
LAST NAME NGUYEN FIRST NAME NGOCHIEN MIDDLE I T
INITIAL
17❑ STREET ❑', 2920 SE 8TH PL UNIT 1113 CITY' RENTON ST WA ZIP 980584416 37
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 DRIVER'S STATE WA ]SEX IF D.O.B. 08 _ 13 _ 1972 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE AMG9638 TATE WA VIN# WA1LFAFP9DA073433
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
GoI
VEH YEAR 2013 MAKE /�(fDI MODEL (,�5 STYLE —FEHICLE
TOWED NOO✓ BLIN TOWED BY v HYES NO 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILY CONNECT AX01771596 STOP
IN EFFECT
- 5
VE""LE ❑ ,J� CITATION# CHARGE I BOTTOM
LEGALLY YES N`LJ 6
25 7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE54960
COLLISION REPORT III III III III III 111
1591972 CASE# 24-1979
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'
On January 23rd at 1530 hours, I responded to a collision at the intersection of Benson Rd S. and
Eagle Ridge, in the city of Renton, county of king, and state of Washington.
Upon my arrival I spoke with the driver of unit 2 and they explained they were going northbound on
Benson Rd S in the number one lane when the collision occurred. The driver of unit 2 stated they
were approaching Eagle Ridge Dr. when unit 1 failed to see them, crossing in front of them. Unit 1
was making a left turn to go southbound at the intersection. Unit 1 sideswiped unit 2's passenger
doors, pushing then down an embankment and completely disabling their vehicle.
I then spoke with the driver of unit 1 and they explained they were stopped facing westbound at the
intersection. They looked North and South from the intersection but did not see any vehicles on the
roadway. They proceeded through the intersection sideswiping unit 2. They could not see because of
the fog that looming around the roadway.
Both vehicles were disabled, and towed away, An exchange of information was given to both drivers.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 02-28-24 06:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 2/29/2024 5:37:47 PM
BADGE OR ID# 12007 OR]# WA0171300 TIME POLICE DISPATCHED 9:97 AM TIME POLICE ARRIVED';9:29 AM
PART I PAGE IT]OF
REPORT NO. EE54960 CASE# 24-1979 DATE AND TIME 02/23/24 09:14
OF COLLISION
Benson Rd S
CD
NTS
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