HomeMy WebLinkAbout25-1109 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF69277OLCERA
COLLISION REPORT 1591971
CASE# 25-1109 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LdCAI-A`NG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E
cDLLISION' 02 - 04 - 2025 0810 17 =.= S 8 W e OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e 18000 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e SE 180TH ST
0 6 29
MOTOR PEDAL- DAMAG THRESHOLD MET E
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO ✓ PHON 0 8 30
5 LAST NAME ROLLINS FIRST NAME DANNEY MIDDLE I W 1 1 2 31
INITIAL
STREET ] 16626 163RD PL SE CITY; RENTON ST WA ZIP; 98058 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs D NOD I INTERLOCK YES[:]NO YES NOD
$ DRIVE E# STATE SEXI M MMDDYY' 03 - 23 - 1943 t 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSINJURY 1 F NATURE of INJURIES 2
10 LICENSE
D62945C srATe WA yIN# 1N6AD06U26C445167 3
TRAILER STATE TRAILER STATE ROM To 11 4 0 PLATE# PLATE#
TRLR TRLR 5 1 33
12 0 0 VIN#' vIN#
FROM TO
VEH.YEAR 2006 MAKE NISS MODEL FRONTI STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOVT VEHICLE g 9 34
13 DAMAGE YES ✓ YES❑ NO✓
REGISTERED OWNER INFO DANNEY ROLLINS 16626163RD PL SE RENTON WA 98058 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 ALL STATE EXCHANGED PRIOR TO MY ARRIVAL
IN EFFECT &POLICY# GQ,
VEHICLE CHARGE ❑ 36
YES❑NO❑ CITATION#
15❑ T Nowc s 7 e
UNIT 02 MO'f CR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE nWNRR
16�
LAST NAME SHEE FIRST NAME NAJAD MIDDLE N
INITIAL
17 F1 STREET ❑❑ 20402 106TH AVE SE APT A101 CITY )(ENT ST, yyq ZIP 980311733 37
NEW ADDRESS
1$❑ IGNITION REQUIREfl IGNf710N PRESENT MEDICALTRAN9PORTEO 38
CDL INTERLOCKYEs No 1NTERLO'K YES No yEs Nal
19 DRIVER'S STATE WA SEX F D.0.8. 01 01 1991 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 7 HELMET 2 INJURY NATURE OF INJURIES ❑ 40
USE CLASS HEAD AND NECK
21 LICENSE CLM5810 rare WA vIN# 3CZRU6H53LM736232 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2020 MAKE HOND MODEL HRV STYLE 5p VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO NAJADSHEE20402106THAVESEAPTA101 KENT WA 980311733 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE[Z INSURANCE CO ALLSTATE EXCHANGED PRIOR TO MY ARRIVAL
IN EFFECT &POLICY# 9TOP
vewcLE YES� N.I,—I CITATION11 CHARGE to BOTTOM
EEGnEEY
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF69277
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1109
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 NJURY 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 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
On 2-4-25 at about 0810 1 heard Officer Leverton call out with an on-view collision at the intersection
of 108th Ave SE and SE 180th st. He was already working a collision at the scene, so I responded to
take the collision. When 1 arrived, I contacted both drivers in the parking lot. Both drivers were
identified via WADL. There was no visible damage to either vehicle and both parties had already
exchanged their information. There was a dispute because driver 2 said she had neck pain. 1 asked
for Renton Fire to come to evaluate the possible injury to driver 2. While waiting driver 1, Danney
Rollins told me;
He was Northbound on 108th Ave SE. As he approached the intersection with SE 180th St he
attempted to stop for the red light and due to the icy roads he slid into the rear of unit 2.
He was not injured.
Driver 2 told me;
She was stopped at the intersection when unit 1 slid into the rear of her vehicle.
She wanted to be evaluated by the fire department.
I released Rollins prior to calling RFA for evaluation of driver 2. Driver 2 was evaluated by RFA and
released. Initially this report was only going to be an exchange of information, but due to the
complaint of injury 1 documented this collision via a report.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 02-24-25 10:17 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
K.LANE 10008 2/26/2025 12:46:54 PM
BADGE OR ID# j 1953 ORI# WA0171300 TIME POLICE DISPATCHED 8:10 AM TIME POLICE ARRIVED i 8:10 AM
PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EF69277 CASE# 25-1109 DATE AND TIME 02/04/2508:10
OF COLLISION
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