HomeMy WebLinkAbout25-4271 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 25-4271 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 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 05 - 1-- 2025 1820 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 43RD ST BLOCK NO. e✓ 1800 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 1.❑ FEET ❑ S ❑ VV❑ 167 NB OFF RAMP
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2069998324 0 4 30
6❑ INITIAL
LAST NAME KISSLER FIRSTNAME NANCY MIDDLE A 1 1 1 31
STREET ❑✓ 12431 56TH PL S CITY SEATTLE ST WA ZIP, 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES 1/ NO
8❑ LRIIVERS STATE WA SEX'F MM DAY' 05 1— 18 — 1964 2 32
CENSE 9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 1 INJURY
CLASS 7 BACK AND NECK PAIN z❑
3❑10 1❑ P1 ATE 14 CSV4002 STATE WA VIN# KNDJT2A57D7514541
F_ TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 5 ] 34
13 2013 KIA SOUL DAMAGE YES NO �MEYER YES❑ No✓
REGISTERED OWNER INFO NANCY KISSLER 1241156TH PL S SEATTLE WA 98178 D:2069998324 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
6 INSURANCE CO 3 4
14 LIABILITY INSURANCE NATIONAL GENERAL 2028753351
IN EFFECT &POLICY# 9TOP
VEHICLe CHARGE to BOTTOM 5 36
LECALLv YES❑NO CITATION# 5A0090686,5A0090687 D WLS 3RD DEGREE,FAIL TO OBEY
15❑ STANDING 7 6
MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑ ❑ PEDESTRIAN ❑ ❑ D:2533346330
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME CHARABA FIRST NAME JAY MIDDLE
INITIAL
17❑ STREET ❑', 113 168TH AVE CT E CITY TACOMA ST WA ZIP 98445 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYEs❑No� INTERLOCK ves No� YES NDF]
19F] DRIVER'S STATE WA SEX M D.C.B. O6 ❑— 23 _ 1996 39
LICENSE# MMDDYY
WELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21❑ LICENSE I CDR2585 TATe I WA VIN1i 2FMDK4KC3EB613792
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2014 MAKE FORD MODEL EDGE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES 11
REGISTERED OWNER INFO JAYCHARABA 113168THAVE CIE TACO.WA 98445 D:2533346330 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO PROGRESSIVE 967094762IN 1 9TOP 5
VETCLE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 7NICH
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
AS SWAN 12965 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF92954
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4271
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
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.
NICHOLAS SWAN 05-14-25 09:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 512012025 2:29:52 AM
BADGE OR ID# 12965 OR]# WA0171300 TIME POLICE DISPATCHED! 6:23 PM TIME POLICE ARRIVED 6:28 PM
FART I PAGE IT]OF 5�
REPORT NO. EF92954 CASE# 25-4271 OF COLLISION
05/14/25 18:20
OF CbLLI510N
NARRATIVE
#25-4271
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 05/11/2025 at approximately 0338 hours I was dispatched to the intersection SW 43rd St and the
northbound SR167 off ramp in the city of Renton, King County, WA, for a blocking accident between
two vehicles.
Unit#1 was a red 2013 Kia Soul with WA LIC: CSV4002 (VIN: KNDJT2A57D7514541)
Unit#2 was a black 2014 Ford Edge with WA LIC: CDR2585 (VIN: 4T1 B11 HK8JU522303)
I arrived on scene and found that both vehicles were blocking the intersection and unable to move
under their own power. The driver of Unit 1 had a complaint of neck, hand, and back pain. The driver
of Unit 2 stated he was okay and did not need medical attention. Both drivers said they were wearing
their seatbelts at the time of the accident.
Renton Fire arrived was on scene and medically cleared the driver of Unit 1. Fire did however
transport the driver of Unit 1 to Valley Medical for further check up at her request due to a recent back
surgery. Unit 2 stated he was okay and did not need medical attention.
Driver 1 of Unit 1 stated she was traveling east bound up SW 43rd St on the overpass above SR167.
She stated she had her hazard lights flashing as her car was struggling to go up the hill. She said she
had a green light as she was driving up to the intersection which then turned yellow. She told me she
proceeded through the yellow light and as she went through the intersection she collided with Unit 2.
Driver 2 of Unit 2, stated he was stopped at a red light after exiting SR167 and was waiting to turn
west on to SW 43rd St. He stated he recalled having a red light and watching it turn green. As the
light turned green and he entered the intersection making a left-hand turn, he stated he was struck by
the driver of Unit 1 in the driver side and rear driver side passenger doors.
Both vehicles were unable to be driven away from the accident location. Gene Meyer towing was
dispatched to remove the vehicles. An impound form was issued to Unit 1 and Unit 2 signed his own
tow form.
I took pictures of the vehicles and uploaded them to Axon Evidence.
An exchange of information was printed and provided to the drivers of both vehicles involved.
At the conclusion of my investigation, I determined that the proximate cause of the collision is due to
Unit 1 not paying attention to the roadway and traffic lights.
If the driver of Unit 1 would have not proceeded through their changing traffic light, while driving
eastbound on SW 43rd St., then this collision would not have occurred.
The driver of Unit 1 had charges forwarded to the Renton Prosecutor under Sector citation
#5A0090686 for DWLS 3rd degree. The driver of Unit 1 was mailed Sector citation #5A0090687 for
failure to obey traffic control device.
This concludes my report.
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 N. Swan #12965 on 05/14/2025 at 2024 hours in the City of Renton.
PAGE 3 OF 5
REPORT NO. EF92954 CASE# 25-4271 OF COLLISION
05/14/25 18:20
OF CbLLI510N
NARRATIVE
PAGE 4 OF 5
REPORT NO. EF92954 CASE# ' 25-4271 DATE AND TIME 05/14/25 18:20
OF COLLISION
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