HomeMy WebLinkAbout25-3199 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EF81581
COLLISION REPRT 1591971
CASE# 25-3199 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL INN 4200 3[--�
COUNTY RD NVOLVED CODING
2 PRIVATE WAY
❑ 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' 04 - 09 - 2025 0838 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
SE PETROV/TSKY RD
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET H S 8 W e 110TH AVE SE
0 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:2066043996 0 1 30
6 LAST NAME HUSER FIRST NAME MADISON MIDDLE A 1 1 2 31
INITIAL
STREET 11002 SE PETROVITSKY RD UNIT C202 CITY RENTON ST WA ZIP 98055 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs ND INTERLOCK YEs NO YEs NO.
8❑ LICIENS# STATE WA SEX F MMoCSYY' 05 — 09 — 2002 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CHE8881 STATE WA VN# JMlBPAMM7K1142723 3
10[9� PI ATP tt
11[—j— TRAILER STATE TRAILER ,STATE ROM TO
11 3 5 PLATE# PLATE#
TRLR TRLR 1 3 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN �tpyENIZ GOVT VEHICLE 3 7 34
13 4 2019 MAZD 3 SD DAMAGE YES NO " "'"' RS YES❑ NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE� INSURANCE CO PROGRESSIVE 991302484 2 3 4
IN EFFECT &POLICY# 4TOP _
srgNOLNG ❑ CITATION# 5AO407880 CHARGE FAIL YIELD PRIVATE RD MOTOR o ooTro6 36
Yes NO
15
MOTCYR PEDAL- E] PEDESTRIAN PEDESTRIAN PROPERTY DAM THR OLD MET PHO
UNIT 02 VEHICLE CYCLE' nWNFR YEs No �/ D:NE 2532669115
16�
LAST NAME PFINGSTEN FIRST NAME JOHN MIDDLE C
INITIAL
STREET ❑ 37
17 '❑ 19609 8TH AVE S CITY DES MO/NES ST, Wq ZIP 981482250
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPORTED'. 38
INTERLOCKYEs No INTERLOCKYES 0NO YEs NO
19 DRIVER'S STATE WA SEY M I "B- 1 04 1 17_ 1979 39
LICENSE# MMODYY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE DERTYFJ TATE WA VIN# JTEBU11FX70064381 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2QQ7 MAKE TOYT MODEL F,/ STYLE (JT VEHICLE TOWED TO BLIN
TOWEDBY GES HI 44
24� DAMAGE YES NO� YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 4588857-C23.47A
IN EFFECT &POLICY# 9TOP
vew1— ❑ ,.I—I CITATION# CHARGE tO BOTTOM
LecnLLr YES No
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF81581
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3199
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
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
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.
C.ARNOLD 04-09-25 11:39 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 4/11/2025 6:41:23 AM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 8:40 AM TIME POLICE ARRIVED 8:44 AM
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47
REPORT No.` EF81581 CASE# 25-3199 COLLI SICiN TIME OF 04/09/25 08:38
COLLI
NARRATIVE
CC 25-3199
On 4/9/2025 at 0840 hours I was dispatched to a motor vehicle collision at the 11000 block of SE
Petrovitsky Rd in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling West on SE Petrovitsky Rd approaching the 11000 block in the
#3 lane preparing to perform a lefthand turn.
Driver 1 stated that she was leaving a private driveway from the Lexington Heights Apartments on the
South side of SE Petrovitsky Rd and preparing to perform a lefthand turn to proceed Eastbound on
SE Petrovitsky Rd.
Collision
Driver 2 stated that as he was proceeding forward in the #3 lane, which is a 2-way center turn lane,
Unit 1 pulled out from the private drive across the #1 and #2 lane and into the #3 lane. Due to traffic
that was stopped in both the #1 and #2 lanes, Driver 2 stated that he was unable to see Unit 1. Driver
2 stated that the front drivers side bumper of Unit 2 collided with the front drivers side wheel well of
Unit 1, causing significant damage.
Driver 1 stated that traffic in the #1 and #2 lane had stopped and were waving her through to perform
her lefthand turn. Driver 1 stated that she crossed both the #1 and #2 lane and was preparing to enter
the #3 lane to merge into the #2 lane of Eastbound traffic. Driver 1 stated that once the front of Unit 1
crossed into the #3 lane the front drivers side bumper of Unit 2 collided with the front drivers side
wheel well of Unit 1.
Injuries
Neither party complained of injuries.
Vehicle Disposition
Unit 1 was inoperable and was towed from the scene. Unit 2 was able to be driven from the scene.
Proximate Cause
I determined that Driver 1 is at proximate cause for this collision because she failed to yield to the
right of way of oncoming traffic when entering a highway from a private road per RCW 46.61.205.
1 certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Arnold #12509 at 09:13 on 4/9/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EF81581 CASE# 25-3199 DATE AND TIME i 04/09/25 08:38
OF COLLISION
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