HomeMy WebLinkAbout25-3355 ("7—
STATETFFiNCERA �I I ��� III I I Iil I I�I1 II{ II I 0 27c .
COLLISION REP F 1591971
CASE 25-3355 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4100 3[�
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL TOTAL UN 7S#OF OBJECT 1 STRUCK 1 8 28
02 RETAINING WALL
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coAT sloN 04 - 14 - 2025 0913 17 a. e W e OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MAPLE VALLEY HWY BLOCK NO.
8 1900 .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 500 00 FEET e✓ S e W 8 I405
2 0 29
M0T6R PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES No F,/ D:2536404269 0 1 30
6 LAST NAME JOHNSON FIRST NAME ASHLEY MIDDLE' M 1 2 31
INITIAL
STREET E:1' 5413 RAINIER DR E CITY BONNEY LAKE WA
NEW ADDRESS S7 ZIP 983918642 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO INTERLOCK YES NO YES NOf,/
DRIVE STATE WA SEX'F MM flYY 07 - 09 - 2003 1 2 32
8❑ L
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H L E7 2 1 ���� 1 NATURE OF INJURIES 2
LICENStt CHR9168 srArE WA WIN# KMHLW4AK3N0007149 3
10 9❑
11 4 0 PLATE# STATE TRAILER PATE# STATE ROM To
TRLR TRLR. 3 7 33
12 4 Q VIN#' VIN#
FROM TO
13 p VEH.YEAR2022 MAKE HYUN MODEL ELANTR STYLE 4D VEHICLDAMAGE TOWED FtjT02fBLIN TOWED BY GOVT.VEHIICL✓ 3 7 34
❑ REGISTERED OWNER INFO SHELLY LASKE 5413 RAINIER DR E BONNEY LAKE WA 98391 IL—llll VEHICLE ccNO.
'II 1
SHADE 1N DAMAGED AREA ❑ 35
A LIABILITY INSURANCE INSURANCE CO 4
14 PROGRESSIVE 972123876
IN EFFECT &POLICY#
VEHICLE CHARGE ❑ 36
EGALI V YES❑NO❑ CITATION# I 14 BOTTOM 5
15❑ Y--Yc a e
yE' MOTOi2 PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE OWNER YES NO D:2534322010
16�
LAST NAME ISLAM FIRST NAME MD MIDDLE: $
INITIAL
17❑ STREET SS 25226 132ND PL SE CITY KENT ST', Wq ZIP 980426615 4
NEW ADDRESS ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
W7ERLOCKvEs NO INTERLOCK ES No YES No,�
19 DRIVER'#
ON DUTY STATUS! AIRBAG 4 RESTR 4 EJECT 1 HELMET
2 INJURY
6 RIGHT LEG PAINS 40
❑LICENSE I 21❑ 41
P ATE# CLH1418 TATf'WA vIN# 7SAYGAEEXRF988561 1
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23� 43
TRLR RLR
VIN#. '[N#,
TOWED BY GO HI 44
VEH.YEAR 2024 MAKE TESL MODEL MODEL Y STYLE 4D DAMIAGE TOWED✓ ND BLIN BANKERS TOW YES NO�/
24
REGISTERED OWNER INFO MD ISLAM 25226132ND PL SE KENT WA 98042 VEHICLE NQ.2
SHAD DAGAREA
LIABILITY INSURANCE ✓ INSURANCE CO METROMILE42-071821-05-01
IN EFFECT &POLICY# tQ��ol
vE" ❑ . 1 CITATION# CHARGEEE'LEY YES N J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
LACY SMITH 12613 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84042
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3355
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) LEE
ADDRESS&PHONE
2532089394 SEX U MMDY DDBYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
1:10' POS. USE CLASS ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYYYY D.O.B. -
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE CFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX I MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. I 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.
LACY SMITH 04-14-25 01:32 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 4/20/2025 1:23:04 PM
BADGE OR ID# 12613 ORI# WA0171300 TIME POLICE DISPATCHED 9:16 AM TIME POLICE ARRIVED i 9:21 AM
PART B 3000-345.160(R1Vt8) PAGE 0 OF 47
TIM
REPORT NO. EF84042 CASE# 25-3355 OF COLLI ION 04/14/25 09:13
OF COLLISION
NARRATIVE
During this incident, I was equipped with a body-worn camera, which records both audio and video.
Portions of this incident were recorded. This report is merely a summary of the incident and is not
intended to be an exact transcription of the entire investigation or what may have been captured with
the recording system.
On 04/14/2025, 1 was assigned to District 22 as the, 1 R22. At approximately 0916 hours I was
dispatched to MAPLE VALLEY HWY SO NB 1405 for an unknown injury accident. This is located in
the city of Renton, the county of King, and the state of Washington.
Unit 1- WA/CHR9168
Unit 2- WA/CLH1418
I contacted the driver and sole occupant of unit 1. 1 positively identified her as Johnson, Ashley via
her Washington State Driver's License. Johnson stated she was traveling Westbound on Maple
Valley Hwy in lane 3 when traffic stopped unexpectedly. Due to this she veered into lane 2 in an
attempt to avoid an accident. When Johnson veered into lane 2 she collided with unit 2 causing unit 2
to veer across lane 1 and hit the concrete retaining wall twice before coming to a complete stop on
the sidewalk. Johnson stated she was not on her phone, that she was wearing her seat belt, and that
she did not sustain any injuries that she was aware of at this time.
I contacted the driver and sole occupant of unit 2. 1 positively identified him as Islam, MD via his
Washington State Driver's License. Islam stated he was traveling Westbound on Maple Valley Hwy in
lane 2 when unit 1 turned into him at about the 1900 block of Maple Valley Hwy. When unit 1 collided
with him it caused him to veer across lane 1 and hit the retaining wall.
Islam complained of right leg pain. Renton Fire evaluated and medically cleared him on scene.
Unit 2 has extensive damage to the right passenger side of the vehicle from the retaining wall and
medium damage on the driver's side from where unit 1 made impact.
Unit 1 had minimal damage to the front right passenger side of the vehicle.
Unit 2 was privately towed from the scene by Bankers tow.
Both drivers stated they were wearing their seat belts.
Based on the evidence on scene, the statements given by the involved parties and the damage to the
vehicles, it appears that unit one was traveling too fast for conditions and was unable to stop to
stopped traffic. Unit 1 then made an illegal lane change and collided into unit 2.
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 L. Smith 12613 on 04/14/2025 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EF84042 CASE# 25-3355 DATE AND TIME 04/14/2509:13
OF COLLISION
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PAGE 4 OF 4