HomeMy WebLinkAbout25-4652 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF96905oc� RA
COLLISION REPORT 1591971
CASE# 25-4652 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4250 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TOTAL 1
TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
GoulsloN' 05 - 28 - 2025 0840 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
S GRADY WAY
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ . FEET e S 8 W e RAINIER AVE S
2 0 29
PEDAL- DAMAG THRESHOLD MET E
UNIT 01 VEHICLMOTORE PHON
❑ CYCLE' ❑ YES NO ✓ O 1 30
5 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP' 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES ND INTERLOCKYEs Nb YEs NO
8 LCEENSE# STATE SEX U MMDDYY+ -=- 1 2 32
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 HELM
USEET 9 CLASS 0 NATURE OF INJURIES 2
LICENSE, CFX2672 STATE WA VIN# 1GKEK13Zl3J120036 3
10[9� PI ATP tt
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# ROM TO
TRLR TRLR 5 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 2003 GMC YUKON DAMAGE YES NO ✓ YES❑ No 5 1 34
REGISTER OWNER INFO LESLIE RAMIZ 4600 DAV15 AVESAPT Dt01 R
4 EDENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 4TOP
v `LE CHARGE t 5 36
IALLr yes❑NO❑ CITATION# HARE 7 o BOTTOM
15❑ STM ING B 7 e
MOTOR PEDAL- : PROPERTY DAM THR OLD MET PHONE
UNIT 02 PEDESTRIAN
VEHICLE CYCLE: nWNPR YES NO
16�
LAST NAME BERG FIRST NAME BRANDI MIDDLE I N
INITIAL
37
❑
17 STREET' 23728 56TH PL S APT 102 CITY KENT ST, WA ZIP 980322830 g
NEW ADDRESS❑
18 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs No INTERLOCK YES No YES ND
19 DRIVER'S STATE WA SEX F I E.O.a- 08 05 1981 39
LICENSE# MMDDYY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICEN� BYH3015 TATE WA VIN# 3CZRU6H72MM731266 41
PLATE 22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR r RLR 43
UIN#. 'IN#.
VEH.YEAR 2021 MAKE HOND MODEL HR-V STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO COREY BERG 2372856TH PL S KENTWA98032 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO STATE FARM 5190292-AO5.47D
IN EFFECT &POLICY# t 9TOP
Vemae
LE ❑ N,.I—I CITATION# CHARGE tO BOTTOM
`.LJ
25 GnILy YES a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF96905
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4652
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME BERG PAXTON D
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE# DOB
23728 56TH PL S APT 102 KENT WA 98032 SEX' M MMDDYYYY 07 - 02 - 2014
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z 2 POS. 7 2 4 1 USE CLASS '1
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD -F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M -T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. USE CLASS r— ----�
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 05-28-25 09:30 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
6/2/2025 8:01:00 AM
C.JACOBS 1953
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 8:47 AM TIME POLICE ARRIVED 8:55 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
EAN
REPORT NO.` EF96905 CASE# 25-4652 O OF COLLI COLLISION TIME 05/28/25 08:40
COLLI
NARRATIVE
CC 25-4652
On 5/28/2025 at 0847 hours I was dispatched to a hit and run motor vehicle collision at the
intersection of S Grady Way and Rainier Ave S in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was in the #1 lane of NB 167 entering the City of Renton at the intersection of
S Grady Way and Rainier Ave S preparing to perform a lefthand turn.
Driver 1 fled the scene after the collision and was unable to provide a statement.
Collision
Driver 2 stated that as she was going straight ahead, Unit 1 was in the #2 lane trying to merge from
the #2 lane to the #1 lane. Driver 2 stated that Unit 1 entered the #1 lane behind her and in doing so
the front passenger side bumper of Unit 1 collided with the rear drivers side quarter panel of Unit 2.
Driver 2 stated that Driver 1 yelled at her from Unit 1's window and then pressed the gas again to
cause a second collision and slide off of Unit 2's rear quarter panel. Driver 2 stated that Unit 1 then
fled East on S Grady Way.
Injuries
No injuries reported.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as
nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety.
Driver 2 advised that she would be able to identify Driver 1 if she saw her again, however, Driver 2
was in fear of retaliation due to the aggressive nature of Driver 1. Driver 2 stated that she does not
wish to assist in prosecution at this time. I provided her with my card to email me if she changes her
mind at a later date.
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 C. Arnold #12509 at 09:25 on 5/28/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EF96905 CASE# 25-4652 DATE AND TIME i 05/28/25 08:40
OF COLLISION
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