HomeMy WebLinkAbout25-481 POLICETRAFF'c" IIIllI111IN II II I REPORT NO. EF57583 5 5 27
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE zs-481 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 01 - 1-- 2025 2352 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO.
667 EDMONDS AVE NE
e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YEs �/No D:2067537858 1 4 30
6❑ LAST NAME KAMIMAE FIRSTNAME TRACY MIDDLE M 1 1 2 31
INITIAL
STREET ❑, 300 VUEMONT PL NE#K102 CITY RENTON ST WA 7jp, 98056 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 06 - 14 - 1963 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� A8041041 sTArI WAurN# 2T3G1RFV7SC496580
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
FT -R TPILF1 1 5 33
12 0 0 VIN#' VIN#
2025 TOYT RAV4 UT plsA FROM 34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13❑ DAMAGE YES ✓ NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 93626987 4
IN EFFECT &POLICY# 9TOP
15
vECEHA"LE 5 36
LLLv res❑NO❑ CITATION# CHARGE 1 o BOTTOM
❑ STANDING 8 7 6
UNIT� VEHICMOTOR
Z CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES✓ H OLD MET PHONE
16❑
LAST NAME SELLERS FIRST NAME KEITH MIDDLE R
INITIAL
17❑ STREET ❑', 667 EDMONDS AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES
t l NO❑
19[—] DRIVER'S STATE WA SEX M D.C.B. 11 05 _ 1967 0 39
LICENSE# MMDDYY
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 0
CLASS ❑
21❑ LICENSE I CMT6589 TAre WA VIN# 1FDXE45S13HA70612
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN 43
TIN##. IN RLR
' #.
VEH YEAR 2008 MAKE MODEL STYLE MH VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO REAL ASSET GROUP LLC 667 EDMONDS AVE NE RENTON WA 98056 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POLICY#E CO UNKNOWN UNKNOWNIN 1 9TOP 5
VEHICLE YES[:] ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLYN
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
N.ODALOV/C 11628 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF57583
COLLISION REPORT III III III III III 111
1591972 CASE# 25-481
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MCCULLOUGH JEREM/S
(LAST FIRST,
ADDRESS&PHONE#
679 EDMONDS AVE NE RENTON WA 98056 2062342685 SEX i U MMDOYyry 03 — 13 — 1985
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELM INJURY
ET CLASS POS, NATURE OF INJURIES
O SEAT USE
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
BEd MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.q.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.
N.ODALOV/C 01-17-25 06:25 PM
INVESTIGATING gFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 111912025 9:53:49 PM
BADGE OR ID# ! 11628 CRI#' WA0171300 TIME POLICE DISPATCHED 11:54 PM TIME POLICE ARRIVED',11:57 PM
PART I PAGE IT]OF 4]
REPORT NO. EF57583 CASE# 25-481 OF COLLISION
01/14/25 23:52
OF CbLLI510N
NARRATIVE
25-481
Unit 1 -WA Lic/A8041041 gray 2025 Toyota Rav4
Driver/registered owner of unit 1 -Tracy Kamimae
Unit 2 -WA Lic/CMT6589 white 2003 FRRV 25 Motorhome (parked and unoccupied)
Registered owner of unit 2 -Real Asset Group LLC / Keith Sellers
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 01-14-2025 at approximately 2354 hours I was dispatched to a collision at 667 Edmonds Ave NE.
Involved parties were waiting for police contact at the location.
I arrived at approximately 2357 hours. I contacted Tracy and a summary of how the collision occurred
is as follows. Tracy was traveling southbound on Edmonds Ave NE and admitted to looking down at
his vehicle radio. He then collided with unit 2 that was parked. The owner of unit 2 was also waiting
outside and had dialed 911.
Tracy declined to be medically evaluated but had just been in another car accident in December of
2024 and had sustained injuries in that collision. He now needed to utilize a walker and appeared to
be in pain. Unit 2 sustained damage to the rear driver side corner. Unit 1 sustained substantial
damage to the front passenger side and was not drivable. Unit 1 was towed by Bankers Towing.
Involved parties were identified by their WA DOL images. Images of both vehicles were uploaded to
evidence.com by Ofc Gall. No citations were issued in this incident. At the time of writing this report, I
have not received insurance information for unit 2.
During this incident I was equipped with body-worn camera which records both audio and video.
Portions of the incident were recorded. This report is merely a summary of the incident and is not
intended to be an exact transcription of the entire investigation or what may have been captured with
the recording system.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by N. Odalovic #11628 on 01-17-2025 at 1830 hours in Renton,
WA.
PAGE 3 OF 4
REPORT NO. EF57583 CASE# ' 25-481 DATE AND TIME 01/14/25 23:52
OF COLLISION
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PAGE 4 OF 4