HomeMy WebLinkAbout25-3508 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-3508 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 7 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
COLLISION.. 04 - 19 - 2025 1217 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 534 00 FMILES EET e S ❑ W e RAINIER AVE S
0 4 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES
,/No D:5202083873 0 11
30
6❑ LAST NAME MAESTAS FIRST NAME ANDREE LEE MIDDLE J 1 1 2 31
INITIAL
STREET ❑, 375 UNION AVE SE UNIT 192 CITY RENTON ST WA ZIP' 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'X MD.
MDDYY 05 - 26 1- 1995 1 2 32
—1 [NATURE OF INJURIES
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 7 HEAD/BACKACHE z❑
3
10 9❑ PI ATE 14 CLF5251 STATE WA VIN#' JM16PBNYXR1710190
----� TRAILER
P STATE PLA Eft STATE
11 0 0 LATE# PLATT E# FROM TO
TRLR. TRLR. 3 5 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 1 2024 MAZD 323 4T DAMAGE YES NO YES❑ NO✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY#VEwcLE CHARGE 36
LEGALLv Yes❑NO❑ CITATION# U�,
5
15❑ NDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067083151
LAST NAME SANDS FIRST NAME ERIK MIDDLE A
INITIAL
17 STREET I25TH STREET CT E CITY' BONNEY LAKE ST' WA ZIP 98391 37
NEW ADDREs�' 20518 1
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 F] LDI IVER # STATE WA SEX M M D.C.B. 01 13 _ 1994 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# D49673D TATE 41
WA VIN# 1GCESCF99C8102085 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2012 MAKE CHEV MODEL COLOR/a STYLE PK DAMAGE TOWED NOO✓ BLIN YES NO 1/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IUL"iKOTITIfl0l�-
7.1 -FVE""LE ❑ ,J� CITATION# CHARGELEGALYYES N`L J25 NAME(PRINT) OFFICER PHONE BADGE OR ID# AGE26Y NGUYEN 13182 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF85881
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3508
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) MAESTAS KIMBERLEYR
(LAST FIRST,
ADDRESS&PHONE# D O.B.
375 UN/ON AVE SE UNIT 192 RENTON WA 98059 SEXi F MMDOYyry 09 - 26 - 1971
PASSENGER Z WITNESS[]FUNIT# 71SEAT HELMET INJURY NATURE OF INJURIES
SEA 3 AIRBAG 2 RESTR. q EJECT USE 2 CLASS 7 HEADBACK ACHE
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
TIMOTHY NGUYEN 04-20-25 12:33 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 1 4/25/2025 9:35:48 PM
BADGE OR ID# 13182 OR]# WA0171300 TIME POLICE DISPATCHED! 12:19 PM TIME POLICE ARRIVED 12:23 PM
PART I PAGE IT]OF 4�
REPORT NO. EF85881 CASE# 25-3508 OF COLLISION
04/19/25 12:17
OF CbLLI510N
NARRATIVE
25-3508
During this incident, I was wearing an Axon body worn camera, and the incident was recorded on
video with audio. Refer to this video for any exact quotations or for an exact sequence of events. The
following is a summary of the events:
On 04/19/2025 at approximately 1227 hours, I arrived at a collision located at 200 S 2nd St, within the
city of Renton, King County, state of Washington. Upon arrival, the assisting Officer had directed the
vehicles into a nearby parking lot. I observed Vehicle 1 with heavy damage along its entire left side. I
observed Vehicle 2 with heavy damage on the front right bumper. I did not observe airbag
deployment in either vehicle.
Driver 1 and Passenger 1 of Vehicle 1 complained of back and head pain. Renton Fire Authority
responded and medically cleared the subjects. Driver 2 did not make any complaints.
I interviewed Driver 1. In summary, Driver 1 was driving westbound in lane 4 on S 2nd St and was
attempting to turn left (southbound) into the Safeway parking lot located at 200 S 2nd St. Driver 1
claimed they were in lane 4 while making the turn when Vehicle 2 collided into their left side.
Passenger 1 of Vehicle 1 reported a similar narrative.
I interviewed Driver 2. In summary, Driver 2 was driving westbound in lane 4 on S 2nd St and
approaching 200 S 2nd St. Driver 2 reported Vehicle 1 was driving westbound in lane 3 and suddenly
turned left (southbound) in front of them. Driver 2 was unable to stop in time to avoid the collision.
Due to the conflicting narratives and no uninvolved witnesses, I am unable to determine what exactly
occurred. I took photos of the collision and uploaded them to Evidence.com. I later provided all
parties with the case number so that they could retrieve the exchange of information. This ends my
involvement on today's date.
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND ACCURATE AND THAT
I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT.
Signature: Officer T. Nguyen #13182
Date, Time, and Place: 04/20/2025 at approximately 1229 hours in the city of Renton, King County,
state of Washington
PAGE 3 OF 4
REPORT NO. EF85881 CASE# ' 25-3508 DATE AND TIME 04/19/25 12:17
OF COLLISION
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