HomeMy WebLinkAbout25-2982 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EF79572
COLLISION REPRT 1591971
CASE# 25-2982 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4100 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 03 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'. 04 - 02 - 2025 1838 17 =.�� S WE IN
OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
BLOCK NO.
BRONSON WAY
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 200 00-1 MILES FEET e✓ S 8✓ E e N 1ST ST
0 4 29
MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2063038104 0 1 30
5 LAST NAME CAKA FIRST NAME SELIN MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 15156 65TH AVE S APT 1015 CITY TUKWILA ST WA ZIP 98188 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO✓ INTERLOCKYEs N ✓ YES No;✓
8� LICIENS# STATE WA SEX F MMoCSYY' 09 — 08 — 1977 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 1 INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE ti� BMH1552 STATE WA VN# JNKCV64E58M129524 3
11[—j— TRAILER STATE TRAILER ,STATE ROM TO
11 3 5 PLATE# PLATE#
rRLR TRLR 2 3 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 3 5 34
13 4 2008 INFI G37 SD DAMAGE YES NO ✓ YES NO
REGISTERED OWNER INFO SELIN CAKA 1515665TH AVE S APT 1015 TUKWILA WA 98188 D:2063038104 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 3 4
14 [ PEMCO CA1857824
IN EFFECT &POLICY# 4TOP
vEnic�E CHARGE 5 36
LecnLLY YES[:]NO[:] CITATION# 7 0 60TTOM
15❑ STMDNc 7 e
III MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT O2 VEHICLE CYCLE nWNFR YES)/ NO D:3609279209
16F1
LAST NAME WILSON FIRST NAME FRIDAY MIDDLEI K
INITIAL
17 F1 STREET ❑❑ 37 4601 S BRANDON ST CITY SEATTLE ST, WA ZIP 981182355 4
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYES No�/ INTERLOCK YES NoF,/ rEs No'✓
19 DRIVER'S STATE WA SEX F I D.QB, 02 13 1970 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 7 HELMET 2 INJURY NATURE A INJURIES 40
USE CLASS KNEE PAIN
21 LICENSEPLATE# C99864P rarE WA vIN# 4TAVL52N9YZ624711 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
TOWED BY GOV HI 44
VEH.YEAR 2000 MAKE TOYT MODEL TA COMA STYLE TR IVE DAMIAGE TOWED�/ No BLIN BANKERS YES NO✓
24
REGISTERED OWNER INFO FRIDAY WILSON 4601 SBRANDON ST SEATTLE WA 981182355 D:3609279209 VEHICLE NQ.2
SHADE DAGAREA
LIABILITY INSURANCE INSURANCE CO PERMANENT GENERAL 53-WA 8059425
IN EFFECT &POLICY#HICL 9TOP
- 5
LEIAIL YES❑ N CL J CITATION# CHARGE t080TTOM
VEE
25 7
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
KEVIN PETERSON 12808 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF79572
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2982
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} CABRILES DIAZ MARYURI A
(LAST,FIRST,
ADDRESS&PHONE# DOB
270 BRONSON WAY NE APT 33 RENTON WA 980564050 SEX' F MMDDYYYY 11 — 10 — 1989
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGERz WITNESS
1 UNIT# 3 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 7 LEFT SHOULDER PAIN
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD —F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M —T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----�
NARRATIVE
I was dispatched to a collision on 04/02/25 at 1839 hours on 1101 Bronson Way N, in city Renton,
King County WA.
Unit 1 BMH1552 Driver: Selin E. Caka (DOB 09/08/1977)
Unit 2 C99864P Driver: Friday K. Wilson (DOB 02/13/1970)
Unit 3 CRT4805 Driver: Leonard G. Garcia-Caldera (DOB 01/30/1987)
Unit 1 was pulling out of the parking lot to head east on Bronson Way N. When pulling across lane 1
she could not see in lane 2 and when pulling forward into lane 2 she hit unit 2. Unit 2 was traveling
South on Bronson Way N in lane 2 when she was suddenly struck by Unit 1. Unit 2 then rear ended
Unit 3 who was sitting in traffic. Unit 3 was facing South on Bronson Way N in traffic when Unit 2
suddenly stuck Unit 3 who was stopped.
Unit 2 stated having knee pain and Unit 3 driver complained of neck pain and the passenger of unit 3
stated to have left shoulder pain. Unit 1 stated no injuries, both unit 2 and 3 were seen on scene by
Renton Fire.
All 3 drivers were given a information exchange with case number on it.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 04/02/2025, 2146 hours at Renton,
WA
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 04-02-25 09:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 4/3/2025 2:47:51 PM
BADGE OR ID# 12808 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:39 PM TIME POLICE ARRIVED 6:42 PM
PART B 3aaa-345-,aa(R11Yas) PAGE 27OF 47
SUPPLEMENTAL REPORT No. EF79572
POLICE TRAFFIC
1 1 8 27
µ ^'� COLLISION REPORT CASE#+ 25-2982
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 NAME # PLACARD.
GWUR NO NUMBER
SOURCE' AXLES1:1 + NAME IF
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
UNIT : 3 �✓ PEDESTRIAN �' vps� No D:7864963816
5 VEHICLE CYCLE OWNER
0 7 29
LAST NAME GARCIA CALDERA FIRST NAME , LEONARD MIDDLE' G
INITIAL
STREET 30
NFW ADnRFG,P 270 BRONSON WAY NE APT 33 CITY RENTON ST I WA ZJP 98056
6 ❑ 1 1 2 31
CDL IGNITION REOUIRED IGNITION PRESENT MECYESD#NSPf7RTED
INTERLOCK YES NO�/ :INTERLOCK YE.
NOS/ YES N...�I
G
DRIVER'S WA SEX M DOB 01
LICENSE MMDDVYv - 30 - 1987
7
HELMET I INJURY NAruRE OF INJURIES
ON DUTY STATUS: AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS :7 NECK PAIN
LICENSE I CRT4805 rar WA VIN# 1G1PC5SBXE7224076
PLATE#
9 TRAILER TRAILER 2
PLATE#r STATE PLATS# STATE
10 ❑ TRLR TRLR
.VIN.#. .VIN.#.
11 0 0 VEH.YEAR2014 MAKE CHEV MODELCRUZE STYLE SD VEHICLE TOWE E T ABLIN TOWED BY GOVT VFHICI F FROM To
DAMAGE YES NO ✓ YES NO
REGISTERED OWNER INFOLEONARD GARCIA CALDERA 270BRONSON WAYNEAPT33 RENTON WA 98056 D:7864963816 SHADE IN DAMAGED AREA 9 9 33
12 3
FROM TO
LIABILITY INSURANCE INSURANCE CO PATRIOT GENERAL 11410049315
IN EFFECT &POLICY# i T ___ m 34
13 eca
vewcuv�e YES N0[jj CITATION# CHARGE
1080TTC7M
s-rnNoiNc � 3 7
MOTOR PEDAL_ ' PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
36
15 LAST NAME FIRST NAME NIIT ALE
MIDDL
❑
16 ❑ STREET CITY ST ZIP
NEW ADDRESS
GDL IGN1T19N REZIUIRED 1GNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES NO INTERLOCK YES NO :YES NO ❑
17 4 37
LLIRIVERS ICENSE# STATE SEX MDDowY' -� C---�
18 ❑ HELMET ❑
INJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ LICENSE TAT VIN# 39
PLATE#
20 ❑ TRAILER TRAILER ❑ 40
PLATE#< STATE PLATE# - STATE
21 ❑ ❑ 41
TRLR TRLR
VIN# VIN#;
42
22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO
23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT I &POLICY# tC;Q
5 44
vewc�e ❑ ❑ CITATION# CHARGE
24 ILLEGALLY VES NO
STIWDING 8 3 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 04-02-25 09:48 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
BADGE ORI AP 13
�0 �26 ORID# 12808 # WA0171300 SUMMERS 43122 PAGE 0OF
-013(R 11l18)
REPORT NO. EF79572 CASE# 25-2982 DATE AND TIME 04/02/25 18:38
OF COLLISION
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