HomeMy WebLinkAbout25-1600 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF68542OLCERA
COLLISION REPORT 1591971
CASE# 25-1600 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LDCAI-AGENCY 4200 3
COUNTY RD NT&RUN CODING
PRIVATE WAY
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#
eaCL s on' 02 - 19 - 2025 1504 17 =.= S 8 W e IN OF e 1070 3
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
RAINIER AVE S
4a� MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------ 1.1 FEET e S 8 W e TOBINAVES
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4257662486 0 1 30
5 LAST NAME BARNWAL FIRST NAME DILIP MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 25913116THAVESE CITY; KENT ST WA ZIP; 980307818 2
NEW ADDRESS
7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYES NO YES NO
8❑ DRIVERCENS # STATE WA SEXI M MMDDYY' 12 — 27 — 1988 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 1
NATURE of INJURIES 2
LICENSE, CNK0219 STATE WA VIN#; JTDADABUIR3017268 3
10 Fq I as ATP rt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR TRLR 3 1 7 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR ZO24 MAKE TOYT MODEL pRIUS STYLE VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE g 1 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO DOXON MOTORS INC 3405 AUBURN WAY N AUBURN WA 98002 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NSURANCE CO GE/CO 6155331322 3 4
IN EFFECT &POLICY# 4TOP _
sVEHICLE rgNOLNG ❑ ❑ 5AO151283 CHARGE FAIL STOP AT STOP o ooTro6 36
YES[:]NO CITATION#
15
MOTCSR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2064835566
16�
LAST NAME GUADIZ FIRST NAME SAMANTHA MIDDLE F
INITIAL
17 F1 STREET ❑❑ 6724 S 112TH PL CITY SEATTLE ST, WA ZIP 981783053 37
NEW ADDRESS
18❑ CDL IGNITION REt3UIRED IGNITION PRESENT MEDICAL TRANSPORTED'. ❑ 38
INTERLOCKYES NO INTERLOCK YES No YES NO
19 DRIVERS STATE WA SEX F D.O.B. 1 12 03 2002 � 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E BIX9659 rarE WA vIN# 5J6RM4H34GL000264 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2016 MAKE HOND MODEL CR-V STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO MARCELINO GUADIZ 6724 S 112TH PL SEATTLE WA 98178 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO AM FAM BX03638115
IN EFFECT &POLICY# 9TOP
LEEIL ❑ CO CITATION# CHARGE to BOTTOM
EEGnEEY YES NCO
s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF68542
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1600
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 GLASS 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 CIASS ----�
: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.
M.LEVERTON 02-20-25 04:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
C.JACOBS 1953 212412025 1:26:42 PM
BADGE OR ID# ; 2517 ORI#s WA0171300 TIME POLICE DISPATCHED 3:05 PM TIME POLICE ARRIVED i 3:08 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF68542 CASE# 25-1600 OF DATE AND r�N + 02/19/25 15:04
O�COLLISION
NARRATIVE
slv/1 straight across ras slv/2 lane 2 nb
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash near the intersection of
Rainier Ave S at S Tobin St.
I contacted the driver of unit 2 who said they were northbound lane 2 Rainier Ave S when unit 1
crossed in front of them. They thought he was attempting to make a left turn/southbound onto Rainier
Ave S. Unit 2 said they basically didnt see unit 1 until he was across her lane. She did not complain
of injury and damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was on Tobin and was going
to cross all 6 lanes of traffic on Rainier Ave S towards the brown bear car wash parking lot. He said
he proceeded and contacted unit 2 in lane 2. He did not complain of injury and damages did not
require a tow truck.
I cited unit 1 ref RCW 46.61.190 FTYROW from stop sign to other traffic/immediate hazard lawful
upon the roadway via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 2/20/2025
PAGE 3 OF 4
REPORT NO. EF68542 CASE# 25-1600 DATE AND TIME 02/19/2515:04
OF COLLISION
4
i
t
4
t ..
c 1
hY
11
y q,`tys
t f�1.t
}
+k
s'
e
�S
2'.
PAGE 4 OF 4