HomeMy WebLinkAbout25-1203 IT �i " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF66359OLCERA
COLLISION REPORT 1591971
CASE# 25-1203 2
INTERSTATE CITY STREET❑ FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAL ING 42QQ 3
HIT&RUN CODING
❑ COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 1 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCLson' 02 - 06 - 2025 1338 17 =.= S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SGRADYWAY BLOCK NO. e 800 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
6 1001.1 00 FEET e✓ S 8 W e TALBOT RD S
1 9 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2062711264 1 9 30
6 LAST NAME ELLSWORTH FIRST NAME DAVID MIDDLE G 1 1 2 31
INITIAL
STREET ❑ 25202 37TH PL S CITY; KENT ST WA ZIP; 98032 2
NEW ADDRESS
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED'. 3
INTERLOCKYEs NO✓ INTERLOCKYEs NO✓ YES NOW
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 11 — 04 — 1963 1 2 32
9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 1 HELMET
9 CLASSY 0 NATURE OF INJURIES 2
10 LI ENSE' BFB1349 STATE WA VIN# JT3VN39W9S8078818 3
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR TRLR. 7 3 33
12 0 Q VIN#' VIN#
FROM TO
VEH.YEAR 1995 MAKE TOY. MODEL 4 STYLE UT V Y EHICLE TOWED TO BLIN TOWED By GOVT V 7 $
VEHICLE 34
13� DAMAGE YES II_II NO ✓ YESII_I) NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A NSURANCE CO 3 4
14 LIABILITY INSURANCE ALLSTATE 987746 240
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t 36
Lemur YES[:]NO[:] CITATION# 7 0 60TTOM
15❑ sTnNowc s 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2064744675
16�
LAST NAME LAI FIRST NAME THANH MIDDLE T
INITIAL
17 F1 STREET ❑ 3405 TALBOT RD S CITY RENTON ST, WA ZIP 98055 37
NEW ADDRESS I I I I I I
❑
18 1 IGNITION REQUIRED IGNITION PRESENT MEDfCALTRANSPORTED': 38
CDL INTERLOCKYES NO✓ INTERLOCI£YES NO✓ YEs NO'✓
19 DRIVERS STATE WA SEXI M 1 08 14 1963 � 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSEPLATE# CKE2584 raTE WA vIN# JTDKB20U787733831 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23= TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 200$ MAKE TOYT MODEL PR/US STYLE 4T VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ NO✓
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO GEIC04344-47.63.48
IN EFFECT &POLICY# 9TOP
veHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
L'EGn��Y YES N`o
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF66359
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1203
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) ACOSTA ABEL
ADDRESS&PHONE#
BOOS GRADY WAY RENTON WA 98057 SEXi M MMDDDYBYYY1
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
Q Q POS. i USE GLASS ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS R PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE 0,SS ----�
: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 GLASS
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.
R.ON/SH/ 02-13-25 01:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
D.SKELTON 9139 211712025 3:49:58 AM
BADGE OR ID# 5738 ORI# WA0171300 TIME POLICE DISPATCHED 1 1:43 Pry] TIME POLICE ARRIVED i 1:55 PM
PAST B 3 aDo-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF66359 CASE# 25-1203 OF DATE AND r�N + 02/06/25 13:38
O�COLLISION
NARRATIVE
Unit 1 and unit 2 were both in a line of cars going through the automated Brown Bear Car Wash at
800 S Grady Way, within the city limits of Renton, King County, Washington State. Unit 1 was ahead
of unit 2. Driver 1 turned the steering wheel of unit 1, causing it to stop forward travel twice; the
conveyor was still moving, and this pushed unit 2 into the rear end of unit 1. Car wash manager Abel
Acosta spoke with both drivers, and driver 1 attributed damage to unit 2's front end and front bumper
to unit 1's trailer hitch riding up over the bumper. Acosta informed driver 1 that he was required to
exchange information with driver 2 Lai; instead, driver 1 drove off the property and north on Talbot Rd
S without exchanging information. Lai took a photograph of driver 1 before he left; the photo was
taken from outside of the open driver's window of unit 1 from the side, but appeared consistent with
unit 1's registered owner, David Ellsworth. On 2/9/2025, 1 was able to reach Ellsworth by phone.
Ellsworth told me that he had not taken any actions to cause the collision; he was on the car wash
conveyor when his steering wheel suddenly deflected without any input from him, and when Acosta
told him that he had caused the collision he had believed that this was some kind of scam so he left. I
explained that a better option would be to wait for Law Enforcement if he was concerned that there
was some kind of fraud going on. Abel provided video from the car wash; the video showed unit 1
stopping, and then rolling backwards on the conveyor twice, causing it to strike unit 2.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: ON CAR WASH CONVEYOR
Motor Vehicle Unit 2
Action Code: ON CAR WASH CONVEYOR
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EF66359 CASE# 25-1203 DATE AND TIME 02/06/2513:38
OF COLLISION> '
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