HomeMy WebLinkAbout24-3410 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF84741OLCERA
COLLISION REPORT 1591971
CASE# 24-3410 2
INTERSTATE CITY STREET❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL CODING
4200 3
COUNTY RD PRIVATE WAY ❑✓ INVOLVED TOTAL
2� TOTAL#OF OBJECT 1 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 04 - 15 - 2025 1522 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
116TH AVE SE BLOCK NO. e 16022 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
6 8 C------�.� FEET e S 8 W
0 1 29
MOTOR PEDAL- DAM AG TSHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NoHRE�/ D:2064761926 0 9 30
6 LAST NAME ENEBRAD FIRST NAME SAL/NA MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 5133 S 212TH ST CITY; KENT ST I WA ZIP; 980321380 2
NEW ADDRESS
7 COE IGNITION REQUIRED IGNITION PRESENT MEflIGAL TRANSPORTED 3
INTERLOCKYES No INTERLOCKYEs NO YEs No
8❑ DRIVER # STATE WA SEXI F MMDDYY' 04 — 11 — 1990 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 NATURE of INJURIES 2
10 LI ENSE' D4302C STATE WA VIN# 1BABNBSA8PF389256 3
TRAILER STATE TRAILER STATE ROM To 11 0 5 PLATE# PLATE#
TRLR rRLR 5 1 33
12 0 Q VIN#' VIN#
FROM TO
VEH.YEAR 2023 MAKE BLOB MODEL T3 RE STYLE VEHICLE TOWED TO BLIN TOWED By GES VEHICLE 9 9 34
13 DAMAGE YES YES) NO
REGISTERED OWNER INFO RENTON SCHOOL DISTRICT300 SW 7TH ST RENTON WA 98057 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A LIABILITY INSURANCE INSURANCE CO 3 4
14 SCHOOLS INSURANCE ASSOCIATION OF WA
IN EFFECT &POLICY# 4TOP
CHARGE 5 36
Lemur yes❑NO❑ CITATION# 7 0 80TTOM
15❑ STMDING s 7 e
UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 T 02 VEHT,O,E CYCLE nWNFR
16�
LAST NAME PARPART FIRST NAME GREGORY MIDDLE P
INITIAL
17 F1 STREET ❑❑ 37 7203 S SUNNYCREST RD CITY' SEATTLE ST, WA ZIP 981782655
NEW ADDRESS
1$� IGNITION REUIREfl IGNITION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCKYES NO INTERLOCK YES No YES NO
19 DRIVER'S' STATE WA SEX,M I D.ox. 1 05 02 1955 39
LICENSE# MMODYY
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21[ LICENSLATE E B6973C raTE WA vIN# 1BABNBSA5JF339146 41
22❑ [TILER TRAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 201$ MAKE BLB MODEL SCHOOL STYLE BIJ VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO RENTON SCHOOL DISTRICT 300 SW 7TH ST RENTON WA 98057 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO SIAW 242534033
IN EFFECT &POLICY# t STOP
vemae
E VEHICLE
YES N CL] CITATION# CHARGE to BOTTOM
V
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 21
3000-345-189(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME ABRIL MURPHY
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY —�—�
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z � 1 POS. 10 2 9 1 USE CLASS i 1 ----�
:NAME
(LAST EIRS7 MIDDLE INITIAL) { SEARS .LAMES
ADDRESS&PHONE#
RENTON SEx' U D•O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 1 PEAT
10 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 ----�
NAME MIDDLE INITIAL) CL/FFORD DEMYA
(LAST,FIRST,
ADDRESS&PHONE# RENTON
SEX UD.O.B. -�
MMDDYYYY
PASSENGER WITNESS UNIT# 1 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET 9NJURY 1 NATURE OF INJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3oDo-345-attar gt 1Mfft. PAGE 2�OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) HARRIS SKY
ADDRESS&PHONE
RENTON SEX i U MpDDVBVYY -�-�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z � 1 POS. : 10 2 9 1 USE CLASS ;1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) VELA KENLEAH
ADDRESS&PHONE#
RENTON SEX' U D G e•
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS1:11 UNIT# : 1 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CIASS 1 ----�
NAME MIDDLE INITIAL) AYLA ALEJANDRO
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX. U M MD _
D.O.B.
DYYYY
PASSENGER WITNESS UNIT# 1 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. 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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PAST B 3 Do-3mx-attar(t 1Mff) PAGE 0 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) BARRY FATIMA
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY —�—�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1 POS. : 10 2 9 1 USE CLASS ;1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) BARRY►SHA
ADDRESS&PHONE#
RENTON SEx' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 1 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CIA SS 1 ----�
NAME MIDDLE INITIAL) SEARS CAND►CE
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX UMMD.O.B.
DDYYYY
PASSENGER WITNESS UNIT# 1 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. 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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3 aDo-3mx-attar gt 1Mfft PAGE F4 --]OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) CLIFFORD ASHTON
ADDRESS&PHONE
RENTON SEX i U MMDDDYBYYY - -
PASSENGER WITNESS UNIT SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z � 1 POS. : 10 2 9 1 USE CLASS i 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) i ABRIL KIMORA
ADDRESS&PHONE#
RENTON SEX' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 1 POS. , 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 ----�
NAME WILLIAMS AMAYA
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# RENTON SEX. U _
D.O.B.
MMDDYYYY
PASSENGER WITNESS UNIT# 1 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PAST B 3 Do-3mx-attar(t 1Mff) PAGE 0 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) PETERSON REIGN
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY —�—�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z � 1 POS. 10 2 9 1 USE CLASS 1 ----�
:NAME
(LAST EIRST,MIDDLE INITIAL) { KIRA KIRA
ADDRESS&PHONE#
RENTON SEX' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 ----�
NAME MIDDLE INITIAL) NICOLAUS NICOLAUS
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX UD.OB. -�
MMDDYYYY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. USE CLASS _ ----�
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3 aDo-3mx-attar(t 1Mff) PAGE 0 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) BAILEE BAILEE
ADDRESS&PHONE
RENTON SEX i U MpDDVBVYY —�—�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) K ARIA
ADDRESS&PHONE#
RENTON SEX' U D O e•
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 PEAT
10 AIRBAG 2 RESTR. 9 EJECT 1 USE CIA SS 1 ----�
NAME(LAST,FIRST,MIDDLE INITIAL) —FUNK ANVI
ADDRESS&PHONE# RENTON
SEX UD.O.B. -�
MMDDYYYY
PASSENGER WITNESS UNIT# 1 2 1 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET 9NJURY 1 NATURE OF INJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3 aDo-3mx-attar(t 1Mff) PAGE 7=OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK COHON
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY -�-�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z � 2 Pos. 110 2 9 1 USE CLASS 1 ----�
:NAME
(LAST EIRST,MIDDLE INITIAL) { UNK DJ
ADDRESS&PHONE#
RENTON SEX' U D•O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 P1:11OS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CJU:R 1 ----�
NAME MIDDLE INITIAL) UNK DESTINY
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX U
MMDDYYYY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY]Pos 1 NATURE OF INJURIES
a � SEA : 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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3 Do-3mx-attar(t 1Mff) PAGE 0 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK MCKELSIE
ADDRESS&PHONE
RENTON SEX i U MMDDDYBYYY - -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS i 1 ----�
:NAME
(LAST EIRST,MIDDLE INITIAL) { UNK MILES
ADDRESS&PHONE#
RENTON SEX' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 ----�
NAME MIDDLE INITIAL) -FUNK RIELLE
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX. U MMDDYY _
D.O.B.YY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
"ART B 3 Do-3mx-attar(t 1Mff) PAGE 0 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK JEFFERSON
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY —�—�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS ;1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) K VALENTINA
ADDRESS&PHONE#
RENTON SEx' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 ----�
NAME(LAST,FIRST,MIDDLE INITIAL) —FUNK MARIA
ADDRESS&PHONE# RENTON SEX UMMD.O.B.
DDYYYY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET 9NJURY 1 NATURECFINJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B3aDo-3mx—,ao(t1Mff) PAGE 10 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK MARIAH
ADDRESS&PHONE
RENTON SEX i U MMDDDYBYYY - -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS i 1 ----�
:NAME
(LAST EIRST,MIDDLE INITIAL) { UNK MATEO
ADDRESS&PHONE#
RENTON SEX' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 P1:11OB. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CJU:R 1 ----�
NAME(LAST,FIRST,MIDDLE INITIAL) —FUNK DIEGO
ADDRESS&PHONE# RENTON SEX UD.OB. -�
MMDDYYYY
PASSENGER WITNESS UNIT# 1 2 1 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. USE CLASS _ ----�
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B3aDo-3mx—,ao(t1Mff) PAGE 11 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK VISH
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY —�—�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS ;1 ----�
:NAME
(LAST EIRS7 MIDDLE INITIAL) { UNK DEXTER
ADDRESS&PHONE#
RENTON SEx' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS1:11 UNIT# : 2 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CIASS 1 ----�
NAME(LAST,FIRST,MIDDLE INITIAL) —FUNK AXEL
ADDRESS&PHONE# RENTON U _
SEX D.O.B.
MMDDYYYY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B3aDo-3mx—,ao(t1Mff) PAGE 12 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK ANGELIQ
ADDRESS&PHONE
RENTON SEX i U MMDDDYBYYY - -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS ;1 ----�
:NAME
(LAST EIRS7 MIDDLE INITIAL) { UNK ISSAC
ADDRESS&PHONE#
RENTON SEX' U D O e•
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 ----�
NAME MIDDLE INITIAL) —FUNK MIRIAM
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX U I D. _
O.B. -C----� C----------�
MMDDYYYY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE CFINJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3 Do-3mx-,ao(t 1Mff) PAGE 13 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK OWEN
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY -�-�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z � 2 POS. 10 2 9 1 USE CLASS 1 ----�
:NAME
(LAST EIRS7 MIDDLE INITIAL) { UNK CARTER
ADDRESS&PHONE#
RENTON SEx' U D•O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 P1:11OS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CJU:R 1 ----�
NAME MIDDLE INITIAL) -FUNK MIKITA
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX UD.OB• -C====�-C=====_____�
MMDDYYYY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET NLASS 1 NATURE OF INJURIES
a � SEAPos USE GLJURY
ASS : _ ----�
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3 Do-3mx-,ao(t 1Mff), PAGE D4l
OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK REGINA
ADDRESS&PHONE
RENTON SEXi U MMDDDYBYYY - -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 PAS. II 10 2 9 1 USE CLASS 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) UNK CRISTOPHER
ADDRESS&PHONE#
RENTON SEx' U D.O.B. _ _C-------�
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 POS. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CLASS 1 ----�
NAME(LAST,FIRST,MIDDLE INITIAL) UNK KYLIE
ADDRESS&PHONE# RENTON SEX U MMDDYY _
D.O.B.YY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET INJURY 1 NATURE OF INJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B3aDo-3mx—,ao(t1Mff) PAGE 15 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK MARK
ADDRESS&PHONE
RENTON SEX i U MpDDVBVYY —�—�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS 1 ----�
:NAME
(LAST EIRST,MIDDLE INITIAL) { UNK FATIMA
ADDRESS&PHONE#
RENTON SEX' U D O e•
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS1:11 UNIT# : 2 POB. 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CIASS 1 ----�
NAME MIDDLE INITIAL) —FUNK LAMARCUS
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX UMMD.O.B.
DDYYYY
PASSENGER WITNESS UNIT# 2 SEAT 10 AIRBAG 2 RESTR. 9 EJECT 1 HELMET 9NJURY 1 NATURECFINJURIES
a POS. USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B3aDo-3mx-,ao(t1Mff) PAGE 16 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK GEORGE
ADDRESS&PHONE
RENTON SEX i U MpDDVBVYY -�-�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 10 2 9 1 USE CLASS 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) K DAN
ADDRESS&PHONE#
RENTON SEX' U D O e•
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 PEAT
10 AIRBAG 2 RESTR. 9 EJECT 1 USE CIASS 1 ----�
NAME MIDDLE INITIAL) —FUNK MATIAS
(LAST,FIRST,
ADDRESS&PHONE# RENTON SEX UD.OB. -�
MMDDYYYY
PASSENGER WITNESS UNIT# 1 2 1 SEAT 10 AIRBAG 2 RESTS. 9 EJECT 1 HELM 1ET INJURY NATURE OF INJURIES
a POS. USE CLASS _ ----�
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B3aDo-3mx-,ao(t1Mff) PAGE 17 OF F21
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84741
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3410
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) UNK ABISH
ADDRESS&PHONE
RENTON SEX i U MpDDYBVYY -�-�
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 110 2 9 1 USE CLASS i 1 ----�
:NAME
Lnsr EIRST,MIDDLE INITIAL) K MCKENZIE
ADDRESS&PHONE#
RENTON SEX' U D OYe
MMDDYYYY
1:11SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# : 2 POS• 10 AIRBAG 2 RESTR. 9 EJECT 1 USE CJU:R 1 ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX I D.O.B. -
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE CLASS
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.
C.ARNOLD 04-15-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/22/2025 2:37:19 PM
BADGE OR ID# 125509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:23 PM TIME POLICE ARRIVED i 3:30 PM
PART B 3 Do-3mx-,ao(t 1Mff) PAGE 18 OF F21
REPORT NO. EF84741 CASE# 24-3410 O OFF COLL1 COLLI r�510NN + 04/15/25 15:22
NARRATIVE
CC 25-3410
On 4/15/2025 at 1523 hours I was dispatched to a motor vehicle collision at Cascade Elementary
School located at 16022 116th Ave SE in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was stopped with children loaded on Unit 2 and waiting.
Driver 1 stated that she was pulling forward in the parking lot of Cascade Elementary School in the
pickup lane with children on board.
Collision
Driver 2 stated that the front bumper of Unit 1 collided with the rear bumper of Unit 2, causing no
significant damage.
Driver 1 stated that the front bumper of Unit 1 collided with the rear bumper of Unit 2 causing no
significant damage.
Injuries
Neither parties nor passengers complained of injuries. Renton Fire Authority was called to the scene
regardless with a dual response to confirm.
Vehicle Disposition
Both vehicles were operable and driven from the scene.
Proximate Cause
This report is for informational purposes only. It should be noted that Driver 2 refused to allow us to
obtain passenger information for the children on board, thus they are only referred to by their first
names.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Arnold #12509 at 16:14 on 4/15/2025 in the City of Renton, King
County, Washington.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Seat Position (Passenger MURPHY ABRIL): ON BUS
Seat Position (Passenger JAMES SEARS): ON BUS
Seat Position (Passenger DEMYA CLIFFORD): ON BUS
Seat Position (Passenger SKY HARRIS): ON BUS
Seat Position (Passenger KENLEAH VEGA): ON BUS
Seat Position (Passenger ALEJANDRO AYLA): ON BUS
Seat Position (Passenger FATIMA BARRY): ON BUS
Seat Position (Passenger ISHA BARRY): ON BUS
Seat Position (Passenger CANDICE SEARS): ON BUS
Seat Position (Passenger ASHTON CLIFFORD): ON BUS
Seat Position (Passenger KIMORA ABRIL): ON BUS
Seat Position (Passenger AMAYA WILLIAMS): ON BUS
Seat Position (Passenger REIGN PETERSON): ON BUS
Motor Vehicle Unit 2
Seat Position (Passenger KIRA KIRA): ON BUS
Seat Position (Passenger NICOLAUS NICOLAUS): ON BUS
Seat Position (Passenger BAILEE BAILEE): ON BUS
Seat Position (Passenger ARIA UNK): ON BUS
Seat Position (Passenger ANVI UNK): ON BUS
Seat Position (Passenger COHON UNK): ON BUS
PAGE 19 OF 21
REPORT NO. EF84741 CASE# 24-3410 OF DATE AND r�N + 04/15/25 15:22
OF COLLISION
NARRATIVE
Seat Position (Passenger DJ UNK): ON BUS
Seat Position (Passenger DESTINY UNK): ON BUS
Seat Position (Passenger MCKELSIE UNK): ON BUS
Seat Position (Passenger MILES UNK): ON BUS
Seat Position (Passenger RIELLE UNK): ON BUS
Seat Position (Passenger JEFFERSON UNK): ON BUS
Seat Position (Passenger VALENTINA UNK): ON BUS
Seat Position (Passenger MARIA UNK): ON BUS
Seat Position (Passenger MARIAH UNK): ON BUS
Seat Position (Passenger MATEO UNK): ON BUS
Seat Position (Passenger DIEGO UNK): ON BUS
Seat Position (Passenger VISH UNK): ON BUS
Seat Position (Passenger DEXTER UNK): ON BUS
Seat Position (Passenger AXEL UNK): ON BUS
Seat Position (Passenger ANGELIQ UNK): ON BUS
Seat Position (Passenger ISSAC UNK): ON BUS
Seat Position (Passenger MIRIAM UNK): ON BUS
Seat Position (Passenger OWEN UNK): ON BUS
Seat Position (Passenger CARTER UNK): ON BUS
Seat Position (Passenger MIKITA UNK): ON BUS
Seat Position (Passenger REGINA UNK): ON BUS
Seat Position (Passenger CRISTOPHER UNK): ON BUS
Seat Position (Passenger KYLIE UNK): ON BUS
Seat Position (Passenger MARK UNK): ON BUS
Seat Position (Passenger FATIMA UNK): ON BUS
Seat Position (Passenger LAMARCUS UNK): ON BUS
Seat Position (Passenger GEORGE UNK): ON BUS
Seat Position (Passenger DAN UNK): ON BUS
Seat Position (Passenger MATIAS UNK): ON BUS
Seat Position (Passenger ABISH UNK): ON BUS
Seat Position (Passenger MCKENZIE UNK): ON BUS
**** END OF AUTO-POPULATED SECTION ****
PAGE 20 OF 21
REPORT NO. EF84741 CASE# 24-3410 DATE AND TIME 04/15/2515:22
OF COLLISION> '
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PAGE 21 OF 21