HomeMy WebLinkAbout25-2272 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF78877oc� RA
COLLISION REPORT 1591971
CASE# 25-2272 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AOENC'Y 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
COLLISION'. 03 - 13 - 2025 0511 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e 000 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 . FEET e S 8 w e AIRPORT WAY
OF 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2067250975 0 4 30
5 LAST NAME TRINH FIRST NAME HON MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 7516 44TH AVE S
NEW CITY SEATTLE ST' WA ZIP 98118 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NOR] INTERLOCKYES N �/ YES D NOW
8 DRIVER'S
STATE WA SEX F MDmopyy' 02 — 20 — 1947 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE ti� BXU1372 STATE WA VN# 5TDKK3DC2CS245554 3
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FROM TO
rRLR TRLR 1 3 33
1 3 5 VIN# vN#
( FROM TO
2
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 8 2012 TOYT SIENNA VN DAMAGE YES NO ✓ YEs❑ No 1 3 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE INSURANCE CO 2 3 4
14 ALLSTATE 820 605 640
IN EFFECT &POLICY# <DQ,
VEHICLE CHARGE 36
YES❑NO❑ CITATION#
15❑ sTnNowc B 7 e
III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:4258307568
16�
LAST NAME RUSSELL FIRST NAME COLE MIDDLEI T
17 F1 INITIAL
STREET �/ ❑
❑ 8530 S 125TH ST CITY I RENTON ST, yyq ZIP 98057 37
NEW AbORESS ':
18❑ CDL IGNITION REQUIRED3 IGNTION PRESENT MEDICAL TRANSPORTED'. 38
INTERLOCKYEs NO NTERLOCKYES NO vEs No;�
19 DRIVER' # STATE WA SEX,M MMDDYY 04 O6 1984 39
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICEN� AFWRTHG TATE WA vIN# 1C4JJXSJ3NW109668 41
PLATE 22❑ [TILER TRAILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2022 MAKE JEEP MODEL WRANGL STYLE VT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO USAA 0203491747105
IN EFFECT &POLICY# t 9TOP
`Hine
Lec ❑ N,.I—I CITATION CHARGE
25 nLLY YES tO BOTTOM
`.LJ
a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
R.ONISHI 5738 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF78877
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2272
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
Both units 1 and 2 were turning from southbound Rainier Ave S to eastbound Airport Way. This
intersection has two left turn lanes; unit 2 was in the outside left turn lane, and unit 1 was in the inside
left turn lane. Unit 1 swung wide in the turn, striking unit 2. Unit 1 front bumper impacted driver's side
of unit 2. Unit 2 was a Jeep with large tires; impact did little or no damage to unit 2, but left rear tire of
unit 2 rolled over front bumper of unit 1, partially tearing it from frame.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 03-13-25 06:23 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 41112025 2:53:02 PM
BADGE OR ID# 5738 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 5:13 AM TIME POLICE ARRIVED 5:16 AM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EF78877 CASE# 25-2272 DATE AND TIME 03/13/25 05:11
OF COLLISION
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