HomeMy WebLinkAbout25-2588 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-2588 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 3 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 03 - 1-- 2025 1900 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
116TH AVE SE BLOCK NO. e✓ 11600 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e SE PETROVITSKYRD
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4253197862 0 11
30
6� LAST NAME POULTON FIRSTNAME DANIEL MIDDLE D 1 1 2 31
INITIAL
STREET ❑, 13415 SE 172ND PL CITy RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
:NTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ DRIVERS
# STATE WA SEXI M I ELMIDI Y' 06 - 14 - 1992 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS
2 CLASS 1 NATURE OF INJURIES z❑
3
10[1PI ATE 14 CLJ2436 sTAr WAu N# 1 G8JU52F11 Y571629
0 TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 $ 34
13 2 2001 STRN L200 4D DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 979780304 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YEs NO ,/ D:2068593315
16 a
LAST NAME ALMONIDOVAR FIRST NAME JENNY MIDDLE I D
INITIAL
17 STREET❑ NEW ADDREss❑' 7533 S 120TH ST CITY SEATTLE ST WA ZIP 98178 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑NOR INTERLOCK yEs It I NOF YES
t l NO❑
19 DRIVER'S STATE WA ]SEX IF D.C.B. 02 _ 18 _ 1995 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CGV5230 TArE WA VIN# 41
JTDBDMHE8PJ001325 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2023 MAKE 7'Dy7' MODEL CORO!! STYLE 4D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO,� 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO STATEFARM 47EZ47947IN 1 9TOP
VEHICLE YES[:] N
C[:] CITATION# CHARGE i o BOTTOM
LEGALLY
25 $
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. EF77332
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2588
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
PM 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 03-21-25 08:34 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THiELMAN 11462 3/26/2025 10:00:15 PM
BADGE OR ID# ( 12809 ORI# WA0171300 TIME POLICE DISPATCHED 7:02 Pry] TIME POLICE ARRIVED',7:07 pry]
PART I PAGE IT]OF
TIME
REPORT NO. EF77332 CASE# 25-2588 OF COLLISIONO3/21/25 19:00
NARRATIVE
25-2588
On 03/21/2025 at approximately 1907 hours, I was dispatched to a non injury vehicle collision,
located at the intersection of 116th Ave SE and SE Petrovitsky Rd within the City Limits of Renton,
County of King, State of Washington.
Upon my arrival I observed the vehicles had moved to 100 feet south of SE Petrovitsky on 116th Ave
SE.
I confirmed that neither of the involved needed medical attention.
Unit 1 driver Daniel Douglas Poulton (DOB 06/14/1992) driving his gray 2001 Saturn L200
(CLJ2436/WA) VIN/1G8JU52F11Y571629
Unit 2 driver ALMONIDOVAR, JENNY DELA CRUZ (DOB 02/18/1995) driving her white 2023 Toyota
Corolla (CGV5230/WA) VIN/JTDBDMHE8PJ001325.
Both drivers were identified by their WADL photo's.
The driver of Unit#1 stated that he was the sole occupant of his vehicle and that prior to the collision
he was traveling eastbound in about 11500 block of SE Petrovitsky Rd in lane 1 closest to the
shoulder. Unit 2 was also traveling eastbound in about 11500 block of SE Petrovitsky Rd in lane 1
closest to the shoulder in front of unit 1. Unit 2 had stopped in the lane of travel as a pedestrian was
crossing the intersection. Unit 1 rear ended unit 2 when she had stopped near the intersection. The
collision caused minor damage to the rear bumper of unit 2 and minor damage to the front bumper
and passenger side head light of unit 1.
The driver of Unit#1 (Poulton) was not paying attention to traffic in front of him. Poulton violated
Renton Municipal Code (RMC) 10-12-25-Inattentive Driving which is defined as any person to drive a
motor vehicle on any public highway, street, alley, or road in an inattentive manner in the City of
Renton. "Inattentive manner" in this section means a lack of: 1) attentiveness required to safely
operate the vehicle under the prevailing conditions, including, but not limited to, the nature and
condition of the roadway, the weather conditions, the presence of pedestrians, the presence of other
traffic, or by the driver focusing or directing the driver's attention to something other than driving the
motor vehicle; or 2) attentiveness that would permit the driver of a motor vehicle to observe anything
resting on, or traveling on, or entering the roadway in time to take appropriate action as
circumstances require. (Ord. 4462, 7-25-94, eff. retroactive to 7-1-94; Ord. 5635, 11-14-11).
Based on the above statements, 1 determined that the Driver of Unit#1 (Poulton) is the proximate
cause for the collision due to inattention causing a collision. Poulton should have been paying closer
attention to the movement of traffic in front of him.
I cited Poulton via mail for Inattention. Both involved vehicles were able to be driven away without
further incident. An exchange of information was provided to all involved parties.
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 (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
PAGE 3 OF 5
TIME
REPORT NO. EF77332 CASE# 25-2588 OF COLLISIONO3/21/25 19:00
NARRATIVE
is true and correct.
Electronically signed by K.Petty, ID# 12809 on 03/21/2025 @2005 hours in Renton WA.
PAGE 4 OF 5
REPORT NO. EF77332 CASE# 25-2588 DATE AND TIME 03/21/2519:00
OF COLLISION
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PAGE 5 OF 5