HomeMy WebLinkAbout25-4433 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF95170OLCERA
COLLISION REPORT 1591971
CASE# 25-4433 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE 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#
eOCL s on' 05 - 20 - 2025 1322 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
RAINIER AVE S
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e S 4TH PL
0 1 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NO �/ D:2066961018 0 6 30
6 LAST NAME DELGARDO FIRST NAME MEKAI MIDDLE O 1 1 2 31
INITIAL
STREET ] 12004 77TH AVE S
NEW ADDRESS CITY I SEATTLE ST: WA ZIP: 981784422 2
7 +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYEs N YES F No
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 08 — 28 — 2004 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR
CLASSY 14 NATURE of INJURIES 2
10 1� aiCENSE' ANL6611 STATE WA VIN# 1C3CCBCGODN522486 3�
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR rRLR 5 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR ZOI3 MAKE CHRY MODEL 200 STYLE VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE g 1 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO ROBERT DELGARD01200477TH AVE S SEATTLEWA98178 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
$ INSURANCE CO 2 3 4
14 LIABILITY INSURANCE STATE FARM 4769619C1447A
IN EFFECT &POLICY# 4TOP 5
vEnicLE CHARGE 7 0 80TTOM 36
15
srnNoiNc yes❑NO❑ CITATION# SA0512644,5A0512644 FOLLOW VEHICLE TOO CLOSELY,OP s 7 e -
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2537409281
16�
LAST NAME ACKER FIRST NAME JACOB MIDDLE' E
INITIAL
STREET ❑ 37
17 ❑ 324 CORRIN AVE SE CITY ORTING ST, WA ZIP 983608012
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YES No INTERLOCK YES R N.Rj Es NO
19 DRIVER'S ' STATE WA SEX M D.O.B. 03 17 2000 � 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21[ LICEN E LATEIBNL9420 rare WA vIN# 1N4AL3APXFN919806 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2015 MAKE pJJ$$ MODEL ALTIMA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO NO
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 940093830
IN EFFECT &POLICY# t STOP
Yewae L'—LY YES❑ N,.I—J I CITATION# CHARGE to BOTTOM
`.L
25 s s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF95170
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4433
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 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
PC& 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.
C.ARNOLD 05-20-25 02:11 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE-
C.JACOBS 1953 512712025 10:00:58 AM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 1:28 Pry] TIME POLICE ARRIVED i 1:43 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF95170 CASE# 25-4433 OF DATE AND r�N + 05/20/25 13:22
O�COLLISION
NARRATIVE
CC 25-4433
On 5/20/2025 at 1328 hours I was dispatched to a motor vehicle collision at the intersection of S 4th
PI and Rainier Ave S in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling North on Rainier Ave S approaching S 4th PI in the #2 lane.
Driver 2 stated that the vehicle in front of him abruptly stopped in the intersection of Rainier Ave S
and S 4th PI causing him to slam on his brakes.
Driver 1 stated that he was traveling North on Rainier Ave S in the #2 lane approaching S 4th Pl.
Collision
Driver 2 stated that when he came to a stop, the front bumper of Unit 1 collided with the rear bumper
of Unit 2.
Driver 1 stated that he did not have time or distance to stop to avoid a collision and as he entered the
intersection of S 4th PI and Rainier Ave S, the front bumper of Unit 1 collided with the rear bumper of
Unit 2. Driver 1 was unable to provide me with up to date insurance. I advised him that he would be
cited for this and that if he does have valid insurance that he can present that to the court and the
infraction shall be dismissed.
Injuries
No injuries reported.
Vehicle Disposition
Both vehicles were operational and did not require a tow.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because the driver of a motor
vehicle shall not follow another vehicle more closely than is reasonable and prudent, having due
regard for the speed of such vehicles and the traffic upon and the condition of the highway.
Driver 1 was cited per RCW 46.61.145 and RCW 46.30.020.
1 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 C. Arnold #12509 at 14:07 on 5/20/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. E F95170 CASE# 25-4433 DATE AND TIME 05/20/25 13:22
OF COLLISION
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