HomeMy WebLinkAbout25-4506 IT �i " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF95433OLCERA
COLLISION REPORT 1591971
CASE# 25-4506 2
INTERSTATE CITY STREET FIRE I
RESULTEDLVED
STOLENSTATE ROUTE OTHER VEHICLE LOL`CODICENC'Y 4100 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#
DATE OF N E IN eDL�ISION' 05 - 22 - 2025 2141 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNSET BLVD NE BLOCK NO.
❑
MILE POST e
4a
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e NB I405
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4253897155 0 1 30
5 LAST NAME JIMENEZ FIRST NAME KELVINS MIDDLE J 1 1 2 31
INITIAL
STREET ] 9265 57TH AVE S
NEW ADDRESS CITY I $EATTLE ST I WA ZIP: 98118 2
7 CDL IGNITION REQUIRED IGNITION ENT MEDICAL TRANSPORTED 3
INTERLOCKYES No%/ INTERLOCK YePRES NO YES NOF,/
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 12 — 27 — 1988 1 2 32
9 ON DUTY❑ STATUS' AIRBAG 1 RESTR 9 EJECT 1 JHELM
USEET 2 CLASSY 1 NATURE of INJURIES 2
LICENSE, CPX3459 STATE WA VIN# JTDJTUD37DD552911 3
10 Fq I PI ATP rt
TRAILER STATE TRAILER STATE ROM To 11 0 0 PLATE# PLATE#
TRLR zRLR. 5 1 33
12 0 0 VIN#' vIN#
FROM TO
HICLE
13 3 VEH.YEAR 2013 MAKE ToYT MODEL YARI$ STYLE 2H VEHICLE TO YED NO fiS46LIN diW9YMEYER YESr`-IVT ENp 3 7 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 LIABILITY INSURANCE INSURANCE CO 4
14 STATE FARM 578 1317 C20-47
IN EFFECT &POLICY# 9TOP
vEnl CHARGE t a 60TFOM 36
LEGALLY yes❑NO❑ CITATION# 5
15❑ STANDING s 7 6
PROPERTY
MOTCYR PEDAL- PEDESTRIAN Y DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE E] ❑ nWNRR vEs�/ No D:2533630300
16�
LAST NAME MAC INDAY FIRST NAME TERESA MIDDLE M
INITIAL
17 F1 STREET ❑
❑ 20529 SE 272ND ST CITY KENT ST, WA ZIP 98042 q 37
NEW ADDRESS
18❑ IGNITION REQUIRED IGNITION : PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCKYES No INTERLOCK YEs NO YES NO
19 DRIVER'S STATE WA SEX F D.02 10 16 1972 39
LICENSE# MMDDYY I —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS CHEST PAINS
21 LICEN E LATEIBFC4630 rarE WA vIN# 1FADP3N20HL246345 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2Q17 MAKE FORD MODEL FD(�`(/$ STYLE 4(-/ VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYER
REGISTERED OWNER INFO FRANCIS BAEHR 20529 SE 272ND ST KENT WA 98042 VEHICLE NO.2
SHADFY DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 4144396-EOI.47A
IN EFFECT &POLICY# 9TOP
VEHICLE ❑ ,J—I CITATION11 CHARGE t080TTOM
LEGALLY YES N
25 7 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JUSTIN KAUPPILA 12883 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF95433
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4506
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 0,SS ----�
: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.
JUSTIN KAUPPILA 05-22-25 11:50 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 5/28/2025 12:06:25 AM
BADGE OR ID# 12883 ORI# WA0171300 TIME POLICE DISPATCHED 1 9:43 PM TIME POLICE ARRIVED i 9:46 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF95433 CASE# 25-4506 OF DATE AND r�N + 05/22/25 21:41
O�COLLISION
NARRATIVE
I arrived at the call location and was able to locate the involved vehicles partially blocking southbound
traffic, just south of the NB 1405 on-ramp.
I went to speak to the driver of Unit 1. My conversation with him is summarized as follows:
Unit 1 explained that he was traveling northeastbound on Sunset Blvd NE approaching the NB 1405
on-ramp.
It should be noted that Unit 1 has a yield sign just before the intersection to enter the NB 1405 on-
ramp.
Unit 1 further stated he had looked both ways to ensure traffic was not approaching before crossing
over the intersection to continue straight onto the freeway. Unit 1 continued and entered the
intersection to head onto the on-ramp when he stated that he suddenly saw Unit 2 headed
southwestbound on Sunset Blvd NE while he was still in the middle of the roadway. This resulted in
the front end of Unit 2 colliding with the front passenger side of Unit 1.
Unit 1 did not complain of any injuries.
I spoke to the driver of Unit 2. She relayed the following information to me:
She was heading southwestbound on Sunset Blvd NE approaching the NB 1405 on-ramp. She stated
that Unit 1 had entered the intersection as she was continuing straight down Sunset Blvd NE. This
resulted in the front end of Unit 2 colliding with the front passenger side of Unit 1.
Unit 2 initally did not report any injuries. However, a short time after my arrival they began to complain
of chest pains. Renton Regional Fire Authority arrived a short time later and evaluated the driver of
Unit 2 for her complaints of injuries.
Gene Meyer tow later arrived and took possession of the two vehicles from the location as they were
blocking and undriveable.
Both drivers of each respective vehicle had left the location with other family that had arrived.
I captured photos on scene and later uploaded them to evidence.com. I provided both drivers a copy
of my business card with the case number inscribed on the back of it.
Based on the totality of circumstances, I believe that Unit 1 is the proximate cause of the collision.
Nothing further.
PAGE 3 OF 4
REPORT NO. E F95433 CASE# 25-4506 DATE AND TIME 05/22/25 21:41
OF COLLISION
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