HomeMy WebLinkAbout25-1733 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-1733 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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# ❑
cowsloN 02 - 1-- 2025 0845 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 3300
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 400 00 FMILES EET e S ❑ W e MONROE AVE NE
1 2 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:9495474254 0 7 30
6� LAST NAME KERBY FIRSTNAME WILLIAM MIDDLE T 1 1 2 31
INITIAL
STREET ❑, 23623 119TH PL SE CITY KENT ST WA ZIP 980313780 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� C01176T sTArI WAurN# 1C6SRFRM3LN255120
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 8 2020 RAM 1500 PK DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO WILLIAM.121121119TH PL SE KENT WA 98031 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI V INSURANCE INSURANCE CO GEIC04624937027EXP4.25 3 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LEGALLY, YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDIN 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES,/ NO D:2063057095
LAST NAME ALARCON FIRST NAME MARSIA MIDDLE G
INITIAL
17 STREET I❑ 17026 122ND AVE SE CITY RENTON ST WA ZIP 980586051 37
NEW ADDREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 D IVEW #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CAA4709 TArE 41
WA VIN# 2HGF62F59EH524125 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
GoI
VEH D
YEAR 2014 MAKE HOND MODEL CIVIC STYLE 4D AMAGE TOWED NOO✓ BLIN TOWED BY v HYES NO,� 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE� &POINSURGY#E CO STATE FARM 438-676882047EIN 1 UR
LGALYYES NEI
25❑ OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
C.JACOBS 1953 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF71745
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1733
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) ALARCON ANA R
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
17026 122ND AVE SE RENTON WA 980586051 SEXi F MMDDYyry 10 - 17 - 1971
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ �+ 2 POS. ' 3 2 4 1 USE 2 1 CLASS ,1
NAME
'(LASTr FIRS' MIDDLE INITIAL)
ADDRESS&PHONE# Ly O B
SEX' MMDDYVYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 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'
On 2-24-25 at about 0906 1 arrived in the 3300 block of NE Sunset Blvd. for a 2-vehicle collision. I
contacted both drivers in or near their vehicles in a nearby parking lot. Both drivers identified
themselves via WADL and presented me with their documents including insurance (electronically).
Driver 1, William Kerby told me;
He was exiting the driveway of the parking lot we were in.
He was making a left turn to get into the 2 way turn lane.
He believed that unit 2 entered the 2 way turn lane as he exited the parking lot.
They collided and then relocated to the parking lot.
He was not injured.
Driver 2 told me;
She was stopped in the 2 way turn lane when unit 1 exited the driveway and collided with the drivers
side of her vehicle.
She nor her passenger were injured.
She wanted to wait for husband to arrive prior to decide if she wanted to get her vehicle towed.
Driver 1 was the proximate cause of the collision because he is exiting a private drive into traffic. He
must make sure it is clear for him to proceed to prevent a collision. I provided both drivers with an
exchange of information and released them.
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
M.LEVERTON 2517 1 31612025 5:31:22 PM
BADGE OR ID# 1953 ORI# ': WA0171300 TIME POLICE DISPATCHED 8:47 AM TIME POLICE ARRIVED 9:02 AM
PART I PAGE IT]OF 3�
REPORT NO. EF71745 CASE# 25-1733 DATE AND TIME 02/24/25 08:45
OF COLLISION
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