HomeMy WebLinkAbout25-1317 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 25-1317 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION'. 02 — 10 — 2025 1456 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 440
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 5 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2068331780 1 4 30
6� LAST NAME GALLOWAY FIRSTNAME DAVID MIDDLE W 1 1 2 31
INITIAL
STREET ❑, 28126 33RD PL S CITY AUBURN ST WA 2jp, 980011833 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
-O B 12 - 10 - 1973 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10� PI ATFBit 65359D sTAT1 WAVIN#' 1 FTYEIZMOJKA52928
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. O 0 33
12 0 0 VIN#' VIN#'
2018 FORD TRANSI VN ❑ FROM
34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE
13 A DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO CITYOFRENTON 3555 NE 2ND ST RENTON WA 98056 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ UABILI INSURANCE INSURANCECO CITY OF RENTON SELF INSURED 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE CHARGE 5 36
LECALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064659030
16❑
LAST NAME FORD FIRST NAME TOMMY MIDDLE R
INITIAL
17❑ STREET ❑', 4249 S 173RD ST CITY' SEATAC ST WA ZIP 981883636 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 LICENSE# STATE WA SEX M MMDDW 07 05 _ 1962 0 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG g RESTR 9 EJECT ''9 USE 9 CLASS 0 ❑
21❑ LICENSE I D53927C TATe WA VIN# 3GT000ELXPG176416
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2023 MAKE GMC MODEL SIERRA STYLE PK DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO MUTUAL OF ENUMCLAW PA91121859IN 1 9TOP 5
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES $ '
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF65428
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1317
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 FIRST 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'
25-1317
On February 10, 2025, at 1456 hours dispatch requested that I respond to a collision that occurred in
the parking lot of Mclendon's, 440 Rainier Ave S, in the city of Renton, county of King, and State of
Washington.
Upon my arrival, I spoke with the driver of unit 1, identified by his WADL as David Galloway, and he
explained he was parked across from unit 2. While exiting his parking stall, another vehicle stopped in
the aisle. David readjusted and moved back into the stall to let the vehicle pass, but the vehicle never
moved. David assumed that the vehicle was waiting for his parking stall, so he proceeded to reverse.
David failed to see unit 2 and subsequently struck unit 2's rear drivers side bumper. Unit 1 sustained
minor damage to its rear bumper.
Unit 2 was unoccupied at the time of the collision, but the owner Tommy Ford said the damage would
be over $1000.
Both vehicles were drivable, so no tows were required. An exchange of information was given to the
involved parties.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 02-11-25 12:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 2/13/2025 4:31:08 PM
BADGE OR ID# 12007 ORI# WA0171300 TIME POLICE DISPATCHED 3:19 PM TIME POLICE ARRIVED 3:31 PM
PART I PAGE IT]OF 3�
REPORT NO. EF65428 CASE# ' 25-1317 DATE AND TIME 02/10/25 14:56
OF COLLISION
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