HomeMy WebLinkAbout25-816 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF60582oc� RA
COLLISION REPORT 1591971
❑ 0 RESULTED I
$ 25-816 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCCODICENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 01 - 25 - 2025 1409 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK NO. e 200 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 75 00 FEET e✓ S 8 W e LAKE AVE S
2 0 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2095316883 0 1 30
5❑ LAST NAME MERCADO FIRST NAME JASON MIDDLE A 1 2 31
INITIAL
STREET ❑✓ 11814 44TH AVE S CITY; TUKWILA ST WA ZIP; 98178 2
NEW ADDRESS
7 +CDL IGN RES IGNITION REQUIRED IGNITION PENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ✓NO INTERLOCKVEs NO✓ YES NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 01 — 05 — 2004 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY',1 [NATURE of INJURIES 2
LICENSE, CLX8192 STATE WA VIN# JH4CL96806CO23385 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR TRLR 3 7 33
12 2 5 VIN#' VIN#
FROM TO
VEH.YEAR 2006 MAKE ACUR MODEL STX STYLE SD VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO OWNEDBYDR/VER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE NSURANCE CO ALLSTATE 820733582 3 4
IN EFFECT &POLICY#VEHICLE 4TOP _
srgNo YES NG ❑ ❑ SA0005654 CHARGE INATTENTIVE DRIVING o ooTrofi 36
NO CITATION#
15
MOTOR ✓ PEDAL- El PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNRR YEs No �/ D:2067231193 N:2069103206
16�
LAST NAME MAYENO FIRST NAME NANCY MIDDLE' A
INITIAL
17 F1 STREET ❑❑ 37 2805 S 125TH ST APT 217 CITY SEATTLE ST, WA ZIP 981682491 4
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDfCAL TRANSPORTED'. 38
IGNITION
NO✓ INTERLOCK YES NO✓ YEs NO✓
19 DRIVERS ' STATE WA SEXI F D.o.B. 05 05 1937 � 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 R U ET 2 INJURY1 NATURE OF INJURIES 40
21 LICENSEPLATE# BQZ4235 TATE WA VIN# 5YFEPRAE8LP028686 41
22❑ PLAILER TE# STATE TAILER PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2020 MAKE TOyT MODEL COROLL STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO✓
REGISTERED OWNER INFO NANCY MAYENO 2805 S 125TH ST APT 217SEATTLEWA98168 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE[Z INSURANCE Co AARP 55PHG426478
IN EFFECT &POLICY# 9TOP
HICL
L'EIL YES❑ NJ—I, CITATION# CHARGE t080TTOM
VEE
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.CHANG 10065 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF60582
COLLISION REPORT III III III III III 111
1591972 CASE# 25-816
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
RTF
On 01-24-2025 at about 1424 hours, I was sent to a collision which took place in the 200 block of S
2nd St, in the City of Renton, King County, Washington.
Upon arrival 1 spoke with the driver of unit 1 and he said he was at fault for the collision. He said he
was driving on lane 3 on S 2nd St and he was making a southbound turn into a private driveway. He
looked forward and thought it was a two way road. There was no oncoming traffic so he turned left.
He forgot it was a one way street and did not look back or to his left and when he changed lanes he
struck unit 2 which was in lane 2.
Driver of unit 2 said she was driving westbound in the 200 block of S 2nd St when unit 1 merged into
her from lane 3.
Driver of unit 1 was not paying attention to his surroundings and traffic. He changed lanes and struck
the unit 2. His inattention was a contributing factor in the collision.
Jason M. Mercado (01-05-2004), the driver of unit 1 was cited for inattention.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 01-26-25 03:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 112912025 1:29:38 PM
BADGE OR ID# 10065 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:24 Pry] TIME POLICE ARRIVED i 2:33 PM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. E F60582 CASE# 25-816 DATE AND TIME 01/25/25 14:09
OF COLLISION
Z>
�nN
1,
s
r, w
,
9 x
gg
�i
PAGE 3 OF 3