HomeMy WebLinkAbout25-4039 �oLcRaiTFFiN 5 0 27c REPORT NO. EF92075
"i ,one COLLISION REP F 1591971
CASE# 25-4039 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 1 STATE ROUTE OTHERF-I VFHICI F LOCAL AGENCY 4200 3[�
HIT&RUN ❑ CODING
❑ COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 1 TRIBAL TOTAL UN 75#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 - 07 - 2025 1525 17 a. e W 8 OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO.
EASTVALLEYRD MILEPOST T
❑ MILEPOST
8 3715
4a .�
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1.= FEET e S e W B
0 1 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE � CYCLE � YES No F,/ D:2537978546 1 4 30
6� LAST NAME CLARK FIRST NAME ANNA MIDDLE M 1 F
2 31
INITIAL
STREET El 17223 SE 264TH ST CITY COVINGTON WA
NEW ADDRESS S7 ZIP 980428324 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERLOCKVES No YES NO
$❑ DRER'SLICENSE# STATE WA SEX'F I D-MMDDW 04 - 01 - 1970 32
9 ON DUTY STATUS AIRBAG 2 RESTR 1 EJECT 3 H U5 E7 5 CLASS 7 NECK AND SHOULDER INJURY NATURE OF INJURIES 2
10❑ 1 PILICn NSE srnrE VIN# KNDJN2A28E7045090 3
11 0 0 PLATE# STATE PLATE#TRAILER STATE FROM To
TRLR TRLR. 3 7 33
12 0 0 VIN#' VIN#
FROM TO
13 9 VEH.YEAR2025 MAKE HDMC MODEL Two STYLE MT VEHICLE
ETOWED Ft1 T02fBLIN TOWED BY GODAMAGVT,VENOCL✓ m34
❑ REGISTERED OWNER INFO HARLEY DAVIDSON 3715 EAST VALLEY RD RENTON WA 98055 D:4T53363636 IL—llll VEHICLE ccNJO..'II 1
SHADE 1N DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO
IN EFFECT &POLICY#
V""LE CHARGE i 5 ❑ 36
EGA,Y YES❑NO❑ CITATION# 10 ftOTTOM
15❑ nomc
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 IvJ ❑ PEDESTRIAN
VEHICLE CYCLE: OWNER YES NO
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET {I��I CITY RENTON ST' ZIP 37
17❑ NEW ADDRESS ❑
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YES No INTERLOCK YES JO YES No
19❑ LICENSE# S1A7E SEX U MMDDYY - _ ❑ 39
20❑ ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 H EET 9 CLASSS 0 NATURE OF INJURIES ❑ 40
21❑ LICENSE rATe vIN1€ 1HGCY1F30PA051985
❑ 41
PLATE#
42
22 [TRAILER TRAILER
PLATE# STATE PLATE S7A7E
23 43
TRLR RLR
VIN# IN#
VEH.YEAR 2023 MAKE HOND MODEL CIVIC STYLE $D DAMIAGE TOWED ND✓ BLIN TOWED BY yES N GO HI 44
O
24 YES
REGISTERED OWNER INFO HONDA OF RENTON 3701 EAST VALLEY RD RENTON WA 98055 D:4255265088 VEHICLE NQ.2
SHADE IN DAMAGED AREA
LIABILITY INSURANCE ✓ INSURANCECO HONDA OF RENTON SELF INSURED 2 3 4
IN EFFECT &POLICY# t 4TOP 5
Venice ❑ U CITATION# CHARGE
25 tOBOTTQM
LEGALLY YES N e
71FFIIER�S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TALAN 12007 WA0171300
PARTA 9000-345-159. (R 11(181 PAGE 01 OF
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF92075
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4039
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 NJURY NATURE OF INJURIES
❑ ❑ POS. I USE CLASS
NARRATIVE
On May 7, 2025, at 1525 hours dispatch requested that I respond to a collision that occurred at
Harley Davidson, 3515 East Valley Rd, in the city of Renton, county of King, and state of Washington.
Employees reported that female, later identified as Ann M. Clark, was test riding a motorcycle when
she sturck a parked vehicle.
Upon arrival, I contacted the involved party and determined that the Anna had sustained an injury to
her shoulder and neck. The Renton Regional Fire Authority (RRFA) later arrived on scene and
treated the involved driver. While on scene, I collected the involved parties driving documents.
An employee, identified as Noelle Fontenot, and others explained that Anna was driving towards the
back of the dealership. As she approached the backside of the property, Anna became fixated on a
parked vehicle and struck the vehicle's driver's side front fender. The vehicle involved was identified
as a 2023 Honda Civic which was parked just outside of the front doors of Honda of Renton.
Anna's friend told me that Anna attempted to grab the front brake but pulled on the throttle instead.
She then hit the parked vehicle.
Anna sustained an injury to her neck and shoulder. I was told by another officer that he suspected
Anna of having a broken collarbone. Anna was transported by TriMed to Valley Medical Center.
I provided all the parties involved with an exchange of information.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
C. Catalan 05/07/2025 Renton
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 05-07-25 06:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
G.BARFIELD 6476 511612025 4:03:45 PM
BADGE OR ID# 12007 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:27 Pry/ TIME POLICE ARRIVED i 3:33 PM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F3
REPORT NO. EF92075 CASE# 25-4039 DATE AND TIME 05/07/2515:25
OF COLLISION
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