HomeMy WebLinkAbout25-3506 ("7—
STATETFF' "CERA II I ��� III I I III I I IIII III II I 0 27c .
,one COLLISION REP F 1591971
CASE 25-3506 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
COAT sloN 04 - 19 - 2025 0719 17 a. S e W 8 OF IN 8 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE4THST BLOCK NO. 8✓ 4700 .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.= FEET e S e WHI
LL AVE NE
OF 4 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YEs ,/NO D:2069492567 0 1 30
g� LAST NAME : SMITH FIRST NAME CHANDLER MIDDLE'' 1 2 31
INITIAL
STREET E:1' 17670 SE 45TH CT CITY BELLEVUE WA
NEW ADDRESS S7 ZIP 98006 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED a
INTERLOCK YEs No,/ INTERLOCKYEs NOW vES Na,/
8❑ LICENSE# STATE WA SEX'M MMDDW 11 - 15 - 1991 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U5 E7 2 CLASS 1 NATURE OF INJURIES 2
LICENSE
BSK8813 STATE WA WIN# 4S3BNAN6XK3030637
10 1❑ 3
11 3 5 PLATE# STATE TRAIPLATE# STATE ROMRA
To
TRLR TRR 7 1 33
12 3 5 vIN#' VIN#
FROM TO
13 4 VEH.YEAR2019 MAKE SUBA MODEL LEGACY STYLE SD VEHICLDAMAGE TOWED Ftl T02fBLIN TOWED BY GOVT.VEHIICL✓ 3 7 34
❑ REGISTERED OWNER INFO OWNED BY DRIVER IIIL—llll VEHICLE ccNJll O..'II 1
SHADE 1N DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PEMCO CA1956425 4
IN EFFECT &POLICY#
CHARGE FAIL YIELD LEFT TURN MOTOR 4TOP
vtwc�t 5 ❑ 36
cAl,Y YES❑No CITATION# 5A0297405 o BOTTOM
15❑ nomc 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE OWNER YES NO D:4259858648
16�
LAST NAME ANDERSON FIRST NAME KELLIE MIDDLE
INITIAL
17 STREET El 17542 SE 133RD ST CITY RENTON I ST WA ZIP 98059 4
NEW ADDRESS ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION pRESEIJT MEDfCALTRANSPORTED 38
W7ERLOCKvEs No INTERLOCkCvEs ao ves No,�
19 LICENSE# STATE WA SEX F MMDaYv 11 20 1968 39
20 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SET 2 INJURYNATURE OF INJURIES 40
CLASS
❑21❑ LICENSE 41
gZC8660 TATf'WA v)N 5XYRKDLF4MG044950 1
PLATE# #
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. '[N#,
GO HI 44
VEH.YEAR 2021 MAKE K/A MODEL SORENT STYLE UT DAMIACLE GE TOWED NO✓O BLIN TOWED BY YES NO
24 YES
REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2
SHADE IN DAMAGED AREA
LIABILITY INSURANCE INSURANCECO STATE FARM 4920252-E10-47A 2 3 4
IN EFFECT &POLICY# t 4TOP 5
VEHICLE YES N`'L-1
❑ „I�1 CITATION# CHARGE tOBOTTOM
LEGALLY
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
J.CARSTENSEN I i 11648 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84043
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3506
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE 0,SS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJU S' 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.
J.CARSTENSEN 04-19-25 08:26 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
J.TRADER 4553 4/20/2025 1:17:22 PM
BADGE OR ID# 11648 ORI# WA0171300 TIME POLICE DISPATCHED; 7:32 Aryl TIME POLICE ARRIVED i 7:39 AM
PART B 3000-345.160(Brute) PAGE 0 OF 47
TIM
REPORT NO. EF84043 CASE# 25-3506 OF COLLI ION 04/19/25 07:19
OF COLLISION
NARRATIVE
On 4/19/25 at about 0730 hours I was working uniformed patrol in my unmarked patrol vehicle when I
was dispatched to a collision at NE 4th ST/ Duvall Ave NE in the City of Renton, King County, WA.
contacted the driver of Unit 1, who was identified by his WA DOL photo, and he relayed the
following:
Unit 1 was traveling eastbound on NE 4th ST at Duvall Ave NE. Unit 1 was waiting in the left turn lane
to turn northbound on Duvall Ave NE. Unit 1 had a blinking yellow left turn arrow, which was turning to
solid yellow and red. Unit 1 turned left since he was already in the intersection. The front left of Unit 1
collided with the left side of Unit 2, causing damage.
I contacted Unit 2, who was identified by her WADL, and she relayed the following:
Unit 2 was traveling westbound in the outside lane. As Unit 2 entered the intersection of Duvall Ave
NE, Unit 2 was struck by Unit 1. This caused damage to the left side of Unit 2.
Both parties exchanged info on-scene and I gave both parties a business card with the case number.
Infraction #5A0297405 was sent via Court Mail to Unit 1 for Failure To Yield Right of Way on Left
Turn..
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing information provided by me is true and correct.
Electronically signed: J. Carstensen #11648
PAGE 3 OF 4
REPORT NO. EF84043 CASE# 25-3506 DATE AND TIME 04/19/2507:19
OF COLLISION
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PAGE 4 OF 4