HomeMy WebLinkAbout25-3542 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-3542 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION 04 - 1-- 2025 2227 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE EXT BLOCK NO. e✓ 200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e TAYLOR AVE SW
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2532456944 0 4 30
6� LAST NAME RAY FIRSTNAME RONALD MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 1342 FOREMAN RD CITY DUPONT ST WA ZIP 983278802 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
✓ I INTERLOCK YES[:]No NTERLOCKYEs NO✓ YES R No
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 6 RESTR 4 EJECT 1 I I [NATURE OF INJURIES
H U EET 2 1 INJURY CLASS 6 CHEST PAIN FROM AIRBAG z❑
3
10[1Pi ATNES# BCZ9160 sTAr WAu N# 1 FMCU9J99HUA62158
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR 2017 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 7 34
13 4 FORD ESCAPE SV DAMAGE YES NO ✓ YES[:] No
✓
REGISTERED OWNER INFO RONALD RAY 1342 FOREMAN RD DUPONT WA 98327 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 992431362
IN EFFECT &POLICY# M'eTOP
vECAIIv Hla.e 5 ❑ 36
res❑NO❑ CITATION# CHARGE BOTTOM
15❑ LE STAIND'INGMOT 8 6
UNIT a2 VE IOCLE CYCLE ❑ PEDESTRIAN ❑ OWNER PEDAL
[:]EA.✓ NO OLD MET PHONE
16 a
LAST NAME GRANDISON FIRST NAME ALISHA MIDDLE K
INITIAL
17 STREET❑ NEW ADOREss❑' 5715 S PILGRIM ST CITY SEATTLE ST WA ZIP 981185849 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO/
19 LDI IVER # STATE WA ]SEX IF M D.C.B. 10 _ 08 _ 1993 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HE 2 INJURY 6 NATURE of INJURIES ❑ 40
USE CLASS WRIST PAIN
❑ILICENSE 21❑ PLA E# BYM5362 TArE 41
WA VIN# 1C4PJLLB9JD573435 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 201E MAKE JEEP MODEL CHEROK STYLE SO VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO ALISHA GRANDISON 5715 S PILGRIM ST SEATTLE WA 98118 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO'E""LE ❑ ,J� CITATION# CHARGE BOTTOM
LEGALLY YES N`L J
25 ' a
=RSE
PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12994 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF86313
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3542
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) VULLOCK MYA
(LAST FIRST,
ADDRESS&PHONE# D O.B.
5715 S PILGRIM ST SEATTLE WA 98118 SEX F MMDDYyry 07 - 17 - 2013
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER WITNESS SEAT UNIT# 2 Pos. 8 AIRBAG'2 RESTR. 4 EJECT USE 2 ICLASS '6 CHEST PAIN PRGM AIRBAG
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. 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.
JAMAAL KEARSE 04-21-25 12:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 412812025 12:55:14 AM
BADGE OR ID# ( 12994 OR]# WA0171300 TIME POLICE DISPATCHED 40:28 PM TIME POLICE ARRIVED',10:32 PM
FART I PAGE IT]OF 4�
REPORT NO. EF86313 CASE# 25-3542 OF COLLISION
04/20/25 22:27
OF CbLLI510N
NARRATIVE
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 4/20/2025, at approximately 2228 hours I was dispatched to a report of a collision at the
intersection of Renton Ave Ext and Taylor Ave SW. Dispatch advised 2 motor vehicle collision with
injuries.
At approximately 2232 hours I arrived on scene. I observed Unit 1 in the middle of the intersection
facing eastbound on Renton Ave Ext. There was significant damage to the front right bumper of Unit
1 and airbags deployed. I observed Unit 2 just east of the intersection facing eastbound. Unit 2 had
significant damage to the front left bumper. Unit 2 airbags did not deploy. 1 contacted the driver of Unit
1 and asked if he was injured and he stated he had some chest pain from the airbag deployment. He
declined aid from Renton Fire. The driver of Unit 2 had complaints of pain to her right wrist and stated
she couldn't move it. The front right passenger of Unit 2 had complaints of chest pain from the
seatbelt. Renton Fire checked out both occupants of Unit 2 and they declined going to the hospital.
The driver of Unit 1 relayed the following information. He was driving eastbound on Renton Ave Ext in
lane 1 of 3 approaching the intersection of Taylor Ave SW. He saw his light change to red when he
was approximately 20ft from the intersection. He tried to hit the brakes but due to the heavy rain and
wet roads his car slid into the intersection. He noticed Unit 2 driving northbound on Taylor Ave SW
and enter the intersection. Unit 1 then struck the front driver side bumper of unit 2 with the front
passenger side of Unit 1. His Airbags deployed and the vehicle had to be towed.
The driver of Unit 2 relayed the following information. She was driving northbound in lane 1 of 1 on
Taylor Ave SW approaching the intersection of Renton Ave Ext. She had a green light so she entered
the intersection. She observed Unit 1 driving eastbound on Renton Ave Ext enter the intersection.
Unit 1 then struck the front driver side bumper of unit 2 with the front passenger side of Unit 1. Her
airbags did not deploy but the vehicle had to be towed.
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 Officer J. Kearse #12994 4/21/2025 0039 Hours Renton, King County,
Washington
PAGE 3 OF 4
REPORT NO. EF86313 CASE# 25-3542 DATE AND TIME 04/20/25 22:27
OF COLLISION
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