HomeMy WebLinkAbout25-3182 )STATETFcN 0 4 27i t
Oc� RA EF80962
COLLISION RESRT 1591971
❑ FIRE ❑ CASE 25-3182 2 5 4
INTERSTATE CITY STREET � RESULTED
1 ❑STATE ROUTE OTHER STOLEN VEHICLE ❑ LOCAL AGENCY 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TRIBAL TOTAL UNITS 8
S#OF 02 SO TRUCK BJECT 1 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
COLLISION' 04 - 08 - 2025 1800 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
MAPLE VALLEY HWY MILE POST
e 2500 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 300 00-1 MILES N E
FEET e✓ S 8 W e SE 5TH ST
2 3 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHiCLE ❑ CYCLE ❑ YEs Vl No D:2062516399 2 3 30
5 LAST NAME AVILA ROMERO FIRST NAME GABINO MIDDLE 1 1 2 31
INITIAL
STREET ❑ 29257188TH AVE SE CITY KENT ST WA ZIP 98042 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 3
INTERLOCKYEs NO W/ INTERLOCKYEs NO�/ YES D Nc Z
8 LCEENSE# STATE WA SEX M MMOCSYY' 02 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 1 INJURY
CLASS 1 NAruRE of INJURES 2
LICENSE, C76416G STATE WA VIN# 1GCEC14V93Z190339 3
10[9� PI ATP tt
11[-C 0] TRAILER 59887AE STATE WA TRAILER ,STATE
11 0 0 PLATE# PLATE# ROM TO
TRLR TRLR 7 1 3 33
12 0 o VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 v GOVT VEHICLE 3 7 34
13 2 2003 CHEV S/LVER PK DAMAGE YES ✓ No � �MEYERS Yes No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO NONE 4
IN EFFECT &POLICY
Le # STOP
vEnmur yes❑NO❑ CITATION# CHARGE 5 36
7 0 80TTOM
15❑ STM ING I s 7 e
III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE OWNER YES�/ NO D:2062099332
16�
LAST NAME GARANA FIRST NAME JORDAN MIDDLEI E
INITIAL
STREET ❑
17 ' 1❑ 9237136TH PL SE CITY RENTON ST, Wq ZIP 98058 7 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNTION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs Now INTERLOGKYEs No,/ vEs Nql�
19 DRIVER'S STATE WA II
SEX M D.O.e. 09 18 2000 39
'..LICENSE# MMDI7YY —
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 H UET 2 SE CLA 1 Y NATURE OF INJURIES 40
21 LICENSE I PATE# CKJ8786 TATE WA VIN# JTNBE46K573126952 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2007 MAKE TOYT MODEL CAMRY STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YE
s,/ NO GENE MEYER YES No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE DEGED AREA
4
LIABILITY INSURANCE INSURANCECO STATE FARM 5114827C2947D
IN EFFECT &POLICY# STOP
1—
LeGnLLr ❑ N,.I—J I CITATION# CHARGE t08OTTOM
`.L
25 YES s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
E.EDMUNDS 12576 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF80962
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3182
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} RODRIGUEZ MEDRANO CESAR
(LAST,FIRST
ADDRESS&PHONE#
29257 188TH AVE SE KENT WA 98042 SEX' M MMDDYYYv 03 - 22 - 2001
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
El 1 POS. 3 2 4 1 USE GLASS
'NAME
LAsr F RST,MIDDLE INITIAL) AVILA ROMERO MONICO
ADDRESS&PHONE#
29257 188TH AVE SE KENT WA 98042 SEX' M D.O.B. 05 _ 04 _ 1995
MMDDYYYY
S INJURY
NATURE OF INJURIE
EAT HELMET S
PASSENGER WITNESS UNIT# i 1 PEA 9 AIRBAG 2 RESTR. 4 EJECT 1 USE GLASS 1 ----�
NAME MIDDLE INITIAL) SIMONSEN DEREK
',(LAST,FIRST,
ADaREss a PHONE# RENTON 4252765668 U D.
_
SEX O.B.MM _F L----------�
DDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q SOS. USE GLASS
NARRATIVE
Unit 2 was Traveling westbound on Maple Valley Highway in the lane furthest away from the curb,
approximately .1 of a mile past SE 5th ST intersection. Unit 1 was traveling eastbound in the lane
closest to the curb at approximately the same location. While navigating the curve in the road, Unit 1
lost control of his vehicle on the wet road, causing his trailer to flip onto it's side and forcing him into
oncoming traffic. Unit 2 struck Unit 1 when it crossed the center line into its lane of travel.
When 1 arrived, both vehicles were damaged and not drivable. Firefighters responded to the scene for
a precautionary evaluation of Driver 2 due to an airbag deployment. Driver 1 and his passengers
stated they were unhurt. Gene Meyers towing removed both vehicles and the trailer.
Driver 1 was cited for speed too fast for conditions and operating a motor vehicle without insurance.
Driver 1 losing control of his vehicle and crossing the center line into oncoming traffic was the
proximate cause of the collision.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by E. Edmunds/#12576 at 1954 hours on 04/08/2025, in the City of Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.EDMUNDS O4-08-25 07:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 4/8/2025 10:25:28 PM
BADGE OR ID# 12576 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:00 PSI TIME POLICE ARRIVED 6:00 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EF80962 CASE# 25-3182 DATE AND TIME 04/08/25 18:00
OF COLLISION
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