HomeMy WebLinkAbout25-2615 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 0 27c
COLLISION REP FIT 1591971
CASE 25-2615 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK' UT/LITYPOLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 03 - 1-- 2025 2307 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 45TH PL BLOCK NO. e✓ 4500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 100 00 FEET e S ❑ W e DAMS AVE S
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4124828443 30
6� LAST NAME SITIENEI FIRSTNAME SALOME MIDDLE C 1 F 2 31
INITIAL
STREET ❑, 1001 S MILDRED ST APT 16 CITY TACOMA ST WA 2jp, 984651802 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 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� CEZ5127 sTArI WAvrN# 5YFBURHE7FP353898
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12❑ vIN#' UIN#
FROM
34
13 3 VEH.YEAR 2015 MAKE TOYT MODEL COROL STYLE 4D VEHICLE TOWED No pLSSBLIN TQ yEq.BLRs YES❑ENO
❑ DAMAGE ILJI tSA1Wl6
REGISTERED OWNER INFO SALOMESITlENE12590727TH PL S APT P203 KENT WA 98032 D:4124828443 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14❑ LIABILI INSURANCE INSURANCE CO STATEFARM 5659296D2547
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
UNIT MOTORVEHIC
❑ CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES H OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ 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 LLIICENS # STATE SEX MMDDYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 1 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF77333
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2615
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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'
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.
KEITH PETTY 03-23-25 12:14 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 312612025 9:58:44 PM
BADGE OR ID# ( 12809 ORI# WA0171300 TIME POLICE DISPATCHED 11:08 PM TIME POLICE ARRIVED',11:11 PM
PART I PAGE IT]OF 4�
REPORT NO. EF77333 CASE# 25-2615 OF COLLISION
03/22/25 23:07
OF CbLLI510N
NARRATIVE
25-2615
On 03/22/2025 at approximately 2308 hours, I was dispatched to the 200 block of S 45th PI in the
City of Renton, King County, Washington, for a single vehicle accident with no injuries.
I contacted the driver Salome Chelagat Sitienei (DOB 09/16/1977) identified by her WADL. She was
driving her gray 2015 Toyota Corolla (CEZ5127/WA) VIN/5YFBURHE7FP353898.
Salome stated she was turning left out of the Chateau Valley Center parking lot locate at 4450 Davis
Ave S in the City of Renton. She accelerated and tried to avoid a vehicle parked on the south side of
the road. She over corrected and hit a light pole (#4016C99) in the planter area.
The Toyota had front end damage causing it to be towed by Banker's towing.
The light pole had minor scratches but nothing that looked like structural damage.
I provided Salome with a business card and case number.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 03/22/25t 2346 hours, Place: Renton, King County, Washington.
PAGE 3 OF 4
REPORT NO. EF77333 CASE# 25-2615 DATE AND TIME 03/22/25 23:07
OF COLLISION
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PAGE 4 OF 4