HomeMy WebLinkAbout25-02803 �oLce RaiTFFi " II (II IIII I III I I IIII III II I 5 3 27c REPORT NO. EF79345
"i ,one COLLISION REP F 1591971
FIRE CASE# 25-02803 2 0 7
INTERSTATE CITY STREET RESULTED
STOLEN
1 2 STATE ROUTE OTHERF-I VFHICI F LOCAL AGENCY 3[�
COUNTY RD ❑✓ PRIVATE WAY HIT 8 RUN CODING
INVOLVED
2 TRIBAL TOTAL N #OF OBJECT 1 STRUCK 1 8 28
UNITS 02 WOOD SIGN POST
RESERVATION 1 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coAT sloN 03 - 28 - 1 1825 17 a. e W 8 OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
MAPLE VALLEY HWY
MILEPOST
8✓ .�
❑4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.= FEET e S e W 8 SE 5TH ST 0 1 29
MOTOR PEDAL- DAM THRESHOLD MET E
/NoUNIT 01 VEHICLE CYCLE Yes IPHON
D:2064684459 0 3 30
g LAST NAME LOPEZ FIRST NAME MATTIAS MIDDLE' J 1 1 2 31
INITIAL
STREET E:1 18920 179TH PL SE CITY RENTON WA
NEW ADDRESS 98058 z
S7 ZIP
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No,/ INTERLOCKYEs NO YES Na,/
8❑ LDICENS STATE WA SEX'M MM,:B 09 - 26 - 2006 1 2 32
9 ON DUTY STATUS' AIRBAG 6 NATURE OF INJURIES
RESTR 4 EJECT 1 H U5 ET 2 CLASS 6 LACERATION ON FOREHEAD FROM AIRBAG 2
LICn NSE CKV9633 srArE WA WIN# JT8GK13T2S0105306
10 9❑ 3
11 0 0 PLATE# STATE TRAIPLATE# STATE ROM To
RA
TRLR TRLR. 7 3 33
12 0 0 vIN#' VIN#
FROM TO
13 2 VEH.YEAR1995 MAKE LEXS MODEL ES250 STYLE SD VEHICLE TOWED 2NOni�ABLIN 9NED.4LRS�OW/NG GOVT.VEHIICL✓ ] 5 34
❑ DAMAGE II_II tlAlVt(t NO.
REGISTERED OWNER INFO CHRtSTYAQU/NO LOPEZ 189TO 179TH PL SE RENTON WA 98058 VEHICLE AM NO. 1 ❑
SHADE 1N DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO B 4
14 TRAVELERS 6072014412031
IN EFFECT &POLICY# STOP
vtwCLt YESCHARGE 5 ❑ 36
EGALl v [:]NO[:] CITATION# 10 BOTTOM
15❑ YT—N. 6
MOTOR � PEDAL PROPERTY M THR OLD MET PHONE
UNIT ICJ ❑ PEDESTRIAN ❑ OIL HO 3603914632
VEHICLE CYCLE OWNER S NO
16�
LAST NAME VEGA GARCIA FIRST NAME ALEJANDRO MIDDLE
INITIAL
17 STREET El 1120 S 25TH ST TRLR 66 CITY MOUNT VERNON ST, WA ZIP 98274 4
NEW ADDRESS 37
❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDI.CALTRANSPORTED � 38
iNTERLOCKvrs NO INTERLOCK Es N YES No,�
19 DRIVER'#
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U E7 2 INJURY
1 NAruRE of INJURIES 40
❑21❑ PLATE 41
D61941C TATE'WA vIN# 5TFC25AN1HX071690 1
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. '[N#,
VEH.YEAR 2017 MAKE TOYT MODEL TACOry/A STYLE PK DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
YES O
24
REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2
SHADE IN DAMAGAREA
2 3
LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 2016818577
IN EFFECT &POLICY# t 4TOP
venue ❑ .1-1 CITATION# tOBOTTQM
�Ecn��v YES N CHARGE
25 J
B 7
OFFICER'S NAME(PRINT)
26 OFFICER PHONE BADGE OR ID# JAGENCY
E.EDMUNDS 12576 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF79345
COLLISION REPORT III III III III III 111
1591972 CASE# 25-02803
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 CLASS ----�
: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.
E.EDMUNDS 03-28-25 07:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
BRYAN GROZA V 12489 1 41212025 9:10:03 PM
BADGE OR ID# 12576 ORI# WA0171300 TIME POLICE DISPATCHED fi:25 Pry/ TIME POLICE ARRIVED i 6:25 PM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF 47
REPORT NO.1 EF79345 CASE# 25-02803 OF COLLI ION 03/28/25 18:25
OF COLLISION
NARRATIVE
Unit 2 was traveling eastbound in the right lane of Maple Valley Highway. Unit 1 was traveling directly
behind Unit 2 in the same direction. Driver 1 stated he didn't notice Unit 2 was making a right turn into
the parking lot until it was too late to avoid a collision and did not stop in time. The front end of Unit 1
struck the rear end of Unit 2 causing significant damage to both vehicles. Unit 2 spun around from the
force of the collision, striking a stop sign. Unit 2 stopped a short distance east of the parking lot
entrance.
I called dispatch for a tow truck due to Unit 1 blocking a lane of travel and being damaged to the
point it was no longer drivable. I requested Firefighters to the scene to evaluate Driver 1 due to airbag
deployment. Unit 2 was drivable and Driver 2 declined medical aid.
Both drivers provided a valid WA drivers license, current registration, and proof of insurance. I
created an exchange of information and provided it to both drivers. Firefighters were delayed getting
to the scene and Driver 1 chose to seek evaluation with family members on scene. Bankers towing
removed Unit 1.
Driver 1, following too closely and being inattentive to the vehicle in front of him was the proximate
cause of the collision.
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 E. Edmunds/#12576 at 1938 hours on 03/28/2025, in the City of Renton, WA.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Location Character: CEDAR RIVER PARK PARKING LOT
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EF79345 CASE# 25-02803 DATE AND TIME 03/28/2518:25
OF COLLISION
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PAGE 4 OF 4