HomeMy WebLinkAbout25-4835 )STATE
TFcN 5 0 27i t
Oc� RA EF98099
COLLISION REPRT 1591971
CASE# 25-4835 2
INTERSTATE CITY STREET❑ FIRE ❑
RESULTED
1 STOLEN Ir
STATE ROUTE ❑ OTHER ❑ VEHICLE � LOCAL AGENCY 4100 3 L--�
COUNTY RD PRIVATE WAY ❑✓ IT&RUN CODING
INVLVED
2❑ TRIBAL UNITS#OF 02 SOT RUCK 5 1 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 06 - 03 - 2025 1604 17 =.= S 8 W E INOF 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE 44TH ST BLOCK NO, e 1700 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 150 00-1 MILES N E FEET e✓ S 8 W e JONES AVE NE
0 1 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE CYCLE' YES NO �/ D:2064037818 30
5 LAST NAME DUONG FIRST NAME KATHY MIDDLE N 1 1 2 31
INITIAL
STREET E:1 2716 20TH AVE S
NEW CITY SEATTLE ST; WA ZIP 981445209 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NOR] INTERLOCKYES N �/ YES D NOW
8 LCEVER'SENSE# STATE WA SEX F MMopyY' 08 — 10 — 1995 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASS 1 NAruRE of INJURIES 2
LICENSE, CLF0428 STATE WA VIN# 7SAYGDEE7RF990835 3
10[9� PI ATF#
TRAILER STATE TRAILER STATE
11 1 5 PLATE# PLATE# ROM TO
rRLR rRLR 5 5 33
12 VIN# VIN
'.....: FROM TO
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 2024 TESL MODEL P4 DAMAGE YES NO ✓ YEs_ No 7 3 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 PROGRESS/VE 945017010
IN EFFECT &POLICY# GQ,
VEHICLE CHARGE 36
YES❑NO❑ CITATION#
15❑ sTANowc B 7 e
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT ❑ ' ❑ PEDESTRIAN Q✓ D:4256636034
VEHICLE CYCLE' nWNFR YES�/ NO
16�
LAST NAME SOTELO DEL ORBS FIRST NAME MIRIAM MIDDLEI R
INITIAL
17 F1 STREET ❑' 12012 SE 91 ST ST CITY NEWCASTLE ST, yyq ZIP 980562040 4 37
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. 38
INTERLOCKYES No INTERLOCK YES No vEs NO
19 DRIVER'S STATE WA SEXI F I D.o.B. 03 O6 1978 39
LICENSE# MMDDYY -
6 HELMET INJURY NATURE OF INJURIES
7 3 4Q
20❑ ON DUTY STATUS 3 AIRBAG RESTR EJECT 2 ❑
USE CLASS COMPLAINT OF PAIN TO RIGHT LEG
LICENSE 21 PLATE# TATE II # 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR r RLR 43
UIN#. 'IN#.
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 1 7 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VEHICLE ❑ ,.I—I CITATION# CHARGE tO BOTTOM
LEEAILY YES N`LJ
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
WA0171300
26
D.NELSON 12421
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EF98099
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4835
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDVVYY
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.
D.NELSON 06-03-25 06:14 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/5/2025 3:03:05 PM
BADGE OR ID# 12421 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 4:04 Pry TIME POLICE ARRIVED 4:14 PM
PART B 3 Do-3mx-,ao(Rtlras) PAGE 27 OF 47
EAN
REPORT NO.` EF98099 CASE# 25-4835 O OF COLLI COLLISION TIME 06/03/25 16:04
COLLI
NARRATIVE
25-4825 ACCINJ
RTF
On 6/3/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of an accident with injury in the parking lot of McDonald's
located at 1705 NE 44th St Renton/King/WA. Kathy Duong DOB: 8/10/1995 was calling to report that
she had accidentally hit a worker in the parking lot who had a complaint of leg pain.
I arrived on scene and located Kathy near her gray 2024 Tesla Model Y WA/CLF0428, Kathy said
that she was parking in a parking spot and a worker was bringing her food out. Kathy said that the
worker was walking around the front of her vehicle, and she thought her vehicle was in reverse. She
moved forward slightly and hit the worker who fell to the ground.
The worker identified as Miriam Sotelo Del Orbe DOB: 3/6/1978 was being evaluated by RRFA.
Mirian had a complaint of pain to her right leg; she was transported to Overlake Hospital for further
evaluation.
Kathy had Tesla footage of the collision, it showed Miriam walking around the front of the vehicle as
Kathy, believing she was in reverse, began to pull out. The Tesla rolled forward and a very slow rate
of speed and collided with Miriam. Miriam winced in pain and stayed standing for several moments
before sitting down on the ground.
This footage was uploaded to Axon Evidence.
This report is for documentation only and information was exchanged at the scene.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 6/3/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EF98099 CASE# 25-4835 DATE AND TIME i 06/03/25 16:04
OF COLLISION
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