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OOLCERAF EF98092
COLLISION REPRT 1591971
CASE# 25-4691 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL AOENC'Y 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
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
coulsloN' 05 - 29 - 2025 1644 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE 4TH ST BLOCK NO. e 4800 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
0 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES ✓NO D:2067300008 0 1 30
6 LAST NAME MENDOZA CABRERAS FIRST NAME JOSE MIDDLE I M 1 1 2 31
INITIAL
STREET E1 20018 BAGLEY DR N APT W307 CITY SHORELINE ST WA ZIP 981331200 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES No INTERLOCKYES N YES R NO
8 LICIENS# STATE WA SEX M MMOCSYY' 07 - 01 - 1987 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CRM2813 STATE WA VN# ML32A3HJXEH005416 3
10[9� PI ATF#
11[—j— TRAILER STATE TRAILER ..STATE ROM TO
11 3 5 PLATE# PLATE#
TRLR TRLR 1 3 33
12 3 5 VIN#' vI.
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 4 2014 MITS MIRAGE DAMAGE YES DNO ✓ YEs_ No 3 7 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14� ABILITY INSURANCE� I&N,. C CY#E CO
IN INTEGON NATIONA INSURANCE 20269888D 3 4
EFFECT POLI 4TOP _
YEs
LE"ALLNG NO CITATION# 5A0512654 CHARGE FAIL YIELD PRIVATE RD MOTOR B o ooTrob 36
15 STM
III MOTCYR PEDAL- PEDESTRIAN PROPERTY fl DAM THR OLD MET PHONE
UNIT Q2 VEHICLE CYCLE nWNFR YES NO �/ D:4257770850
16�
LAST NAME ✓ONES FIRST NAME SARAI MIDDLE N
INITIAL
STREET ❑ 37
17 ' 4306 NE 6TH CT CITY RENTON ST, WA ZIP 980594713
NEW ADDRESS
18 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 38
INTERI_OCKYEs NO INTERLOCK YES No vEs NO
19 DRIVER' #
INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE CBK7126 TATE WA VIN# 5FNYF6H71NB025987 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q22 MAKE HOND MODEL PILOT STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGAREA
2 3
LIABILITY INSURANCE INSURANCE CO AAA 1104845244
IN EFFECT &POLICY# I 9TOP 5
VEHICLE LEGALLY ❑ N`LJ
,.I—I CITATION# CHARGE tO BOTTOM
25 YES a 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. EF98092
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4691
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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 05-29-25 05:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/5/2025 3:08:15 PM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 4:46 PM TIME POLICE ARRIVED 4:49 pry]
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
EAN
REPORT NO.` EF98092 CASE# 25-4691 O OF COLLI COLLISION TIME 05/29/25 16:44
COLLI
NARRATIVE
CC 25-4691
On 5/29/2025 at 1646 hours I was dispatched to a motor vehicle collision at the 4800 block of NE 4th
St in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was traveling West on NE 4th St entering the 4800 block in the #3 lane.
Driver 1 stated that he was facing South out of a parking lot at the 4800 block of NE 4th St preparing
to perform a lefthand turn onto NE 4th St to proceed East.
Collision
Driver 2 stated that Unit 1 exited the parking lot across lane #1 and lane #2, and then into lane #3.
Driver 2 stated that she did not have time to stop, and the front passenger side bumper of Unit 1
collided with the rear passenger side wheel of Unit 2.
Driver 1 stated that the vehicles in lanes #1 and #2 stopped to allow him through. Driver 1 stated that
after crossing lanes #1 and #2, he entered lane #3 and was unable to avoid a collision. Driver 1
stated that the front passenger side bumper of Unit 1 collided with the rear passenger side wheel of
Unit 2.
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 the driver of a vehicle about
to enter or cross a highway from a private road or driveway shall yield the right-of-way to all vehicles
lawfully approaching on said highway.
Driver 1 was cited per RCW 46.61.205.
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 17:33 on 5/29/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EF98092 CASE# 25-4691 DATE AND TIME i 05/29/25 16:44
OF COLLISION
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