HomeMy WebLinkAbout25-3951 ("7—
STATE.w,-" .:.. TFFiNCERA �I I ��� III I I Iil I I�I1 II{ II I 0 27c .
,one COLLISION REP F 1591971
CASE# 25-3951 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE ❑ OTHER VFHICI F ❑ LOCAL AGENCY 4500 3
HIT 8 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 05 - 04 - 2025 1955 17 a. e W 8 OF IN 8 1070 3
S ❑
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK ST 8 160 .�
4a 9❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 2 �. FEET ❑ S ❑ W 8 1405
OF 4 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ,/No D:2063779667 0 1 30
g LAST NAME LAURIE FIRST NAME TESSIE MIDDLE' L 1 2 31
INITIAL
STREET E:1' 7115 35TH PL NE Ci7Y MARYSVILLE WA
NEW ADDRESS S7 ZIP 98270 z
7❑ COL IGNITION RECtUIRED IGNITION PRESENT MEDICALTRANSPOftTED 3
INTERLOCK YES No,/ INTERLOCKYES NOW YES NO,/
DRIVE STATE WA SEX'F MM flYY 06 - 10 - 1972 1 1 2 32
$❑ L
9 F] ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASS 1 NATURE OF INJURIES 2
LICENSE
BYW3835 STATE WA WIN# 1C4HJXFG4MW696877
10 9❑ PI ATLA 3
11 3 5 PLATE# STATE TRAIPLATE# STATE ROM To
RA
rRLR TRLR 7 1 33
12 3 5 vIN#' VIN#
FROM TO
13 4 VEH.YEAR2012 MAKE JEEP MODEL WRANG STYLE 4C VEHICLETOWEED2NOD fBLIN TvR FBYMEYER Govv�ENOL� 3 7 34
❑ DAMAGE II1I._IIII -IIJJ
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE 1N DAMAGED AREA ❑ 35
4 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 THE GENERAL 53-WA 6863953
IN EFFECT &POLICY# 4TOP _
VEHICLE CHARGE i 5 ❑ 36
EGALl v YES[:]NO[:] CITATION# 10 BOTTOM
15❑ GT—N. 6
MOTOR � PEDAL-: PROPERTY DAM THR OLD MET PHONE
UNIT 02 t�J ❑ PEDESTRIAN ❑ ❑ D:5202791114
VEHICLE CYCLE OWNER YES NO
16�
LAST NAME COLEHOUR FIRST NAME ' MARIAH MIDDLE' C
INITIAL
17❑ STREET 1:1 665 FERNDALE PL NE CITY RENTON I ST WA ZIP 98056 4
NEW ADDRESS ❑ 37
1$❑ CDL IGNITION RE®UIRED IGNITION PRESENT MEDICAL TRANSPORTED 3$
W7ERLOCKvE ND INTERLOCkCvEs no ves No,�
19 DRIVER'#
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N U MEET 2 IINLJAURY 1 NATURE of INJURIES 40
❑21❑ LICENSE BRC5073 TATf'W 41
A vIN# 1G2MN35639Y108078 1
PLATE#
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. '[N#,
Y
VEH.YEAR 2009 MAKE PONT MODEL $DL$TI(� STYLE $D DAMIAGE TO YES V NOO BLIN TOWED B GO GENE MEYER YES N HI 44
O V
24
REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2
SHADE IN DAMAGED AREA
LIABILITY INSURANCE INSURANCE CO GEICO 4617706371 3 4
IN EFFECT &POLICY# t 4TOP 5
—1-1 ❑ U CITATION# CHARGE tOBOTTQM
LEGALLY YES N
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JONATHAN SELBERT 12641 WA0171300
PART A . PAGE 01 OF
9000-345-159(R 11(181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF90817
COLLISION REPORT III III III III III 111
1591972 CASE# 25-3951
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 GLASS 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 CIASS ----�
: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 GLASS
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.
JONATHAN SELBERT 05-04-25 09:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 1 511212025 11:59:03 PM
BADGE OR ID# i 12641 ORI# WA0171300 TIME POLICE DISPATCHED 1 7:53 Pry/ TIME POLICE ARRIVED i 8:00 PM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF 47
REPORT NO.1 EF90817 CASE# 25-3951 OF COLLI ION 05/04/25 19:55
OF COLLISION
NARRATIVE
I arrived on scene and observed two vehicles, Vehicle 1 and Vehicle 2, on the shoulder of the
northbound on ramp to 1405 from Sunset Boulevard NE.
observed significant front-end damage to the driver's side of Vehicle 1, including a broken axel.
I observed significant damage to the driver's side of Vehicle 2.
Driver 1 stated that she was driving eastbound on Sunset Boulevard NE. She stated she is unfamiliar
with the area and was attempting to turn left onto the northbound on ramp. As she began to cross the
oncoming traffic lane to do so, she observed Vehicle 2 driving towards her. She attempted to avoid
Vehicle 2, but could not, and struck it on the driver's side.
Driver 2 stated that she was driving westbound on Sunset Boulevard NE when Vehicle 1 suddenly
attempted to cross her lane. She attempted to avoid being struck by Vehicle 1, but was unable to do
so. Vehicle 1 struck her vehicle with its front end.
Fire was on scene and evaluated both drivers. They had no injuries.
Both vehicles were removed from the scene by Gene Meyer towing.
I photographed both vehicles and the scene.
There is no traffic control at this busy intersection to help prevent accidents such as these.
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. Seibert (12641) in the City of Renton, King County, Washington
State on 5/4/2025 at 2107.
PAGE 3 OF 4
REPORT NO. EF90817 CASE# 25-3951 DATE AND TIME 05/04/2519:55
OF COLLISION
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PAGE 4 OF 4