HomeMy WebLinkAbout25-1840 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF70617oc� RA
COLLISION REPORT 1591971
INTERSTATE CITY STREET❑ FIRE I
CASE# 25-1840 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LdCAI-AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 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#
eaCL s on' 02 - 27 - 2025 1037 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION BLO❑
MAPLE VALLEY HWY MILE POST
e 4000 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �.� FEET e S8 We 131STAVESE
2 0 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2069194333 0 1 30
5 LAST NAME PENH FIRST NAME SARA MIDDLE N 1 1 2 31
INITIAL
STREET ❑✓ 6995 SE 8TH PL CITY; RENTON ST I WA ZIP; 98059 2
NEW ADDRESS
7� +COL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NG✓ INTERLOCKVEe NO✓ YES F NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 10 - 10 - 1956 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 [NATURE of INJURIES 2
10 LI ENSE' AGV0539 STATE WA VIN# 5FNYF4H61CB013282 3
TRAILER STATE TRAILER STATE ROM To 11 4 0 PLATE# PLATE#
TRLR TRLR. 7 1 3 33
12 4 0 VIN#' vIN#
FROM TO
VEH.YEAR 2012 MAKE HOND MODEL PILOT STYLE P4 VEHICLE TOWED fj TO ZBLIN TOWED BY GOVT VEHICLE 7 $ 34
13 DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
$ INSURANCE CO 2 3
14 LIABILITY INSURANCE GE/C04482-42-61-88
IN EFFECT &POLICY#
VEHICLE CHARGE 7 0 80TTOM 36
srnNoiNc YES❑NO❑ CITATION# 5AO109121 FLD SIGNAL STOPS/TURNS-UNSAFE
15
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2532665298
16�
LAST NAME ALLEN FIRST NAME JORDAN MIDDLE L
INITIAL
STREET ❑ 37
17 ❑ 26324 SE SUMMIT LANDSBURG RD CITY RAVENSDALE ST, WA ZIP 980519668 4
NEW ADDRESS
18❑ IGNITION REQUIRED IGNITION I PRESENT MEDICAL TRANSPORTED 38
CDL INTERLOCKYES ND✓ INTERLOCK YES
FcDL Wo✓ YEs ND✓
19 DRIVERS ' STATE WA SEX M D.DDY 03 — O7 1992 � 39
LICENSE# MMDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U ET 2 INJURY 1 NATURE OF INJURIES 40
21 LICENSE
LATE# BRU0329 rare WA vIN# 1HGCG1650YA077105 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2000 MAKE HOND MODEL ACCORD STYLE P4 VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24� DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO JORDAN ALLEN 26324 SE SUMMIT LANDSBURG RD RAVENSDALEWA980519668 D:2532665298 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO GEIC04804-82.87.90
IN EFFECT &POLICY# t STOP
YemaE ❑ N`.L J
,.I—I CITATION# CHARGE to BOTTOM
25 LEE—Y YES e
7DNE
'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SON 12421 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF70617
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1840
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) lM SOVANNTHA N
ADDRESS&PHONE#
6995 SE 8TH PL RENTON WA 98059 2069194333 SEXi F MMDDD B. 09 — 09 — 1957
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z 1 1 POS. 3 2 4 1 USE 1 2 CLASS 1 ----�
:NAME
(LAST EIFS7 MIDDLE INITIAL)
ADDRESS R 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
25-1840 COLL
On 2/27/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a two-vehicle blocking collision at 4040 Maple Valley
Highway Renton/King/WA. An involved party was calling to report that they were blocking one lane of
Maple Valley Highway.
I arrived on scene and located Unit 2; a silver 2000 Honda Accord WA/BRU0329 driven by Jordan L
Allen DOB: 3/7/1992. Jordan said that he was driving east in the number one lane of Maple Valley
highway when a police vehicle travelling west came into view. He said that he slowed down as Unit 1
began to merge into his lane from the number two lane. Jordan said that Unit 2 struck his driver side
front quarter panel and front bumper as he merged into Jordan's vehicle. Jordan was not injured, and
his vehicle was drivable.
Unit 1, a gray 2012 Honda Pilot driven by Sara Penh DOB: 10/10/1956, had damage to the
passenger side rear quarter panel. Sara said that he was driving in the number two lane when he saw
the police vehicle with emergency lights activated. He said that he tried to move right when he struck
Unit 2 in the number one lane. Sara was not injured, and his vehicle was drivable.
Based on the damage and Sara's statement I completed Sector citation #5A0109121 for RCW
46.61.305 Turning, stopping, moving left or right-Signals required. I explained that this citation will be
mailed to Sara at his address.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 2/27/2025 Renton WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.NELSON 02-27-25 01:04 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 31312025 10:07:35 AM
BADGE OR ID# 12421 ORI#s WA0171300 TIME POLICE DISPATCHED 11:06 AM TIME POLICE ARRIVED i 11:15 AM
PART B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3
REPORT NO. EF70617 CASE# 25-1840 DATE AND TIME 02/27/2510:37
OF COLLISION
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