HomeMy WebLinkAbout25-4531 IT �i " II IIIII III IIIII II IIII IIIII I . 7 27c REPORT NO EF94391OLCERA
COLLISION REPORT 1591971
CASE# 25-4531 2
INTERSTATE ❑ CITY STREET FIRE I
RESULTEDLVED
STOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 3
COUNTY RD NT&RUN CODING
PRIVATE WAY
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK ❑
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 05 - 23 - 2025 1724 17 =.= S 8 W❑ OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW 43RD ST BLOCK NO. e 4300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e EAST VALLEYRD
0 1 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4256382164 1 2 30
6❑ LAST NAME JORDAN FIRST NAME KARLTON MIDDLE J 1 2 31
INITIAL
STREET ] 1024 CENTRAL AVE N APT C11 CITY; KENT ST WA ZIP; 98032 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION ENT MEDICAL TRANSPORTED 3
INTERLOCKYES ✓ I No NTERLOCKY4PRES NC ✓ YES NO✓
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 10 - 13 - 1989 1 2 32
-NJUR
9❑ ON DUTY STATUS' AIRBAG 2 RESTR 2 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2❑
LICENSE, CJL5692 STATE WA VIN#; 2GKFLVE30G6275469 3
10 Fl I PI ATF tt
❑ TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# 11R.M To
TRLR rRLR. 7 1 5 33
12 3 5 VIN# vIN#
' FROM TO
VEH.YEAR 2016 MAKE GMC MODEL TERRAI STYLE UT VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 5 34
13� DAMAGE YES II_II NO ✓ YESII_I) NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 11
35
14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP _
Lrn Lyc ❑ ❑ 5AO449973 CHARGE OP MOT VEH W/OUT INSURANCE s t a oorrob z 36
Yes NO CITATION# 11
15❑ MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES NO ✓ D:2403867210
16�
LAST NAME KUANG FIRST NAME YIN MIDDLE'
INITIAL
STREET ❑
17 ❑ 3501 OLYMPIC ST SE CITY AUBURN ST, WA ZIP 98002 37
NEW ADORE SS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYEs No✓ INTERLOCKYEs No✓ vEs No✓
19 DRIVER'S STATE WA SEX F I D.O.B. 02 23 1972 39
LICENSE# MMDD Y -
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 LICENSE CPY8534 TATE WA VIN# JTDACACU6R3038568 41
22❑ PLAILER TE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2024 MAKE TOYT MODEL PR/US STYLE qp VEHICLE 44
TOWED TO BLIN
TOWED BY GOV HI
24❑ DAMAGE YES NO✓ NO✓
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLEE NQ.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE✓ INSURANCECO AMERICAN FAMILY INSURANCE SX12521334
IN EFFECT &POLICY# t STOP
V—L ,J—I CITATION# CHARGE to BOTTOM
LEGn�Y YES❑ N`[
25 s '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
DAVID DOUGHERTY 13183 WA0171300
❑
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF94391
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4531
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
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 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
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.
DAVID DOUGHERTY 05-23-25 07:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 512412025 7:59:54 PM
BADGE OR ID# j 13183 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:41 PM TIME POLICE ARRIVED i 5:48 PM
PAST B 3 Do-lmx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF94391 CASE# 25-4531 O OF COLLI r�510NN + 05/23/25 17:24
COLL1
NARRATIVE
Collison Case 25-4531
1 was working as a fully uniformed City of Renton Police Officer in a subdued marked City of Renton,
Police Car as unit#3R18. Working in the City of Renton, County of King, State of Washington.
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized. At the time of this call my body worn camera
was activated.
On 5/23/2025, at 1741 hours, I was dispatched to East Valley Road and SW 43rd Street for a report
of a non-blocking non injury collision involving a 2024, Gray Prius, WA plate CPY8534 and a 2016
Silver GMC Terrain, WA plate CLJ5692.
The updated call notes read that the vehicles had pulled into the parking lot of the Extra Mile Gas
Station on SW 43Rd Street.
When 1 arrived, 1 contacted the reporting party and unit 2 driver Yin Kuang (DOB 02/23/1972) who
had been driving the Toyota Prius. Yin explained that she had was attempting turn right onto East
Valley Highway from SW 43rd Street using the right-hand yield lane. Yin stated she stopped due to a
vehicle travelling southbound on East Valley Highway. Yin stated when she stopped the vehicle
behind her rear ended her. 1 observed minor damage on Yin's rear bumper that I took a photo of and
later uploaded to evidence.com.
I spoke to the unit 1 driver of the 2016 GMC Terrain, Karlton J Jordan (DOB 10/13/1989). Karlton
explained that he was behind the 2024 Prius on SW 43rd Street, and stated the driver stopped
suddenly as they were in the right-hand yield lane, causing his vehicle to collide with her rear bumper.
Karlton admitted he was the at fault driver and stated he did not have valid insurance.
I completed an exchange of information sheet for both Yin and Karlton and provided them each with a
copy listing the case number on it. 1 also wrote Karlton a ticket for operating a motor vehicle with out
insurance under Cite #5A0449973 that I handed to him. Nothing further at this time.
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 D. Dougherty on 05/23/2025 at 1926hours, In the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. E F94391 CASE# 25-4531 DATE AND TIME 05/23/25 17:24
OF COLLISION
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PAGE 4 OF 4