HomeMy WebLinkAbout25-3485 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-3485 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4150 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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# ❑
cawsloN 04 - 18 - 2025 0815 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e✓ 765
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 3 29
UNIT
MMO tOR� Z PEDAL- ElDAMAGE THRESHOLD MET PHONE
01 CYCLE YES NO 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYES NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE# STATE SEX u MMDOOYY - 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H USEEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE STATE VIN#'
10 2❑ Pr ATF�
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 7 5 33
12❑ VIN# VIN#
FROM TO
❑ VEH.YEAR ZOOO MAKE MODEL STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 9 DAMAGE YES NO ✓ YES❑ NO✓
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 UABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LECALLv YES NO CITATION# 10 BOTTOM
15❑ STAIN,D" 8 6
UNIT U2 MOTORVEHIC
❑ CYCLE ❑ PEDESTRIAN ❑✓ OWNER YES
❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME NAKED FIRST NAME CALVIN MIDDLE L
INITIAL
17 STREET❑ NEW ADOREsS❑' 2101 SW SUNSET BLVD APT A109 CITY RENTON ST WA ZIP 98057 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I No� YES t l NO❑
19 DRIVE # STATE SEX M MMDDYY 10 _ 20 _ 1972 39
ON DUTY STATUS 3 AIRBAG RESTR EJECT I H U SET NJAURSY 7 PAIN ON RIGHT SIDE LEG/HIP 40
❑21❑ TATE 41
LICENSE VIN# `1
PLATE#
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4 1 G DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF84742
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3485
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) THOMAS STEPHEN M
(LAST FIRST,
ADDRESS&PHONE#
522 WELLS AVE S RENTON WA 98057 2534199936 SEX M MMDOYyry 08 - 23 - 1983
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ ❑✓ POS. USE :CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYV
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.MMDD -❑
YYYY.
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.
C.ARNOLD 04-18-25 09:15 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 1 412212025 2:34:04 PM
BADGE OR ID# 12509 OR]#` WA0171300 TIME POLICE DISPATCHED 8:29 AM TIME POLICE ARRIVED]8:35 AM
PART I PAGE IT]OF 4�
REPORT NO. EF84742 CASE# 25-3485 OF COLLISION
04/18/25 08:15
OF CbLLI510N
NARRATIVE
25-3485
On 4/18/2025 at 0829 hours I was dispatched to a hit and run vehicle vs pedestrian collision at the
Speedway Gas Station located at 765 Rainier Ave S in the City of Renton, King County, Washington.
Pre-Collision
Unit 2 stated that he was walking along the West side of Rainier Ave S at the 765 block on the
sidewalk, proceeding North along the sidewalk.
Collision
Unit 2 stated that as he crossed the sidewalk at the 765 block, a green or blue pickup truck came to
the exit of the parking lot and failed to stop at the posted stop sign where he was walking on the
sidewalk and the front bumper of Unit 1 struck Unit 2's left leg. Simultaneously, Unit 2 stated that he
slapped the hood of Unit 1. The force of the impact was not great enough to knock Unit 2 to the
ground.
Unit 2 stated that the suspect vehicle fled the area Southbound on Rainier Ave S. Unit 2 was unable
to provide a license plate for Unit 1. Unit 2 stated that the driver of Unit 1 was possibly a white male.
Unit 2 stated that he is willing to assist in prosecution but is unsure if he will be able to identify the
suspect if seen again.
Witness 1 was unable to provide a license plate for Unit 1. Witness 1 stated that he believes that Unit
1 was green, and that the driver was a Hispanic male.
Injuries
Unit 2 complained of pain on his right side. Renton Fire Authority informed me that it is likely nerve
pain from the collision. Unit 2 was medically transported to Valley Medical Center via Tri-Med.
Vehicle Disposition
Unit 1 was operational and fled the scene.
Final Disposition
Unit 1 is described as a green of blue early 2000's pickup truck and Driver 1 is a White or Hispanic
male with dark colored hair.
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 C. Arnold #12509 at 09:06 on 4/18/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EF84742 CASE# 25-3485 DATE AND TIME 04/18/25 08:15
OF COLLISION
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PAGE 4 OF 4