HomeMy WebLinkAbout25-5079 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EGO1271oc� RA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE ❑
CASE# 25-5079 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOL`CO AGENCY. 4100 3
COUNTY RD NVOLVED CODING
2❑ TOTAL PRIVATE WAY
TRIBAL UN TS#OF 02 SOBJECT 17RUCK 0 5 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsfoN' 06 - 10 - 2025 1512 17 =.= S 8 W e IN OF M 1070 a
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
RAINIER AVE S BLOCK NO. e 100 .�
4a 9❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
0 1 29
MOTtlR ✓ PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE CYCLE' YES NO �/ D:2067251767 30
5 LAST NAME SYPERT FIRST NAME ROSELAND MIDDLE J t 1 2 31
INITIAL
STREET E:1 9243 39TH AVE S
NEW ADDRESS CITY SEATTLE ST WA ZIP 981184826 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYES NO YES D NO
8 DRIVER'S
STATE WA SEX F MDmo,YY' 09 — 25 — 1951 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEE7 INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE'ti� ADX9096 STATE WA VN# 4T1CA30P34U013747 3
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# ROM TO
TRLR TR R 5 1 33
12 VIN# VIN
PP:... FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 4 2004 TOYT SOLCP DAMAGE YES DNO ✓ YEs_ No✓ 7 3 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE NSURANCE CO 3 4
14 ALLSTATE 917780648
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t 5 36
Lemur YES❑NO❑ CITATION# 7 o BOTTOM
15❑ sTANowc B e
MOTOR PEDAL-:. 'PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE' nWNFR YES�/ NO D:2068024204
16�
LAST NAME WASHINGTON FIRST NAME ZEMAR/ON MIDDLE D
INITIAL
STREET ❑
17 'O 6036 S 119TH ST CITY SEATTLE 5T, WA ZIP 98178 37
NEW AbbRESS
18 CDL IGNITION REQUIRED IGNTION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES No jNTERLOCYEs rlN�o vEs Noi
19 LICIENSE# STATE SEX M MM DYY 07 — 24 2011 39
20❑g HELMET INJURY NATURE OF INJURIES 40
ON DUTY STATUS 3 AIRBAG RESTR EJECT USE CLASS ju I CONFIRMED BROKEN ANKLE AT HOSPITALLICENSE — ❑
21 PLATE# rarE VIN# 41
22❑ [TILER TRAILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
GOV H 44
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY I
24 Q 6 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
vemaE ❑ ,.I—I CITATION# CHARGE tO BOTTOM
LEEAI�Y YES N`LJ
25 a 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF
3000-345-159(R 11/181
POLIICFETRAFFICN CORRECTION REPORT NO. EGO1271
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5079
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 06-11-25 06:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/16/2025 2:00:52 PM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:14 Pry TIME POLICE ARRIVED 3:98 Pm
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EGO1271 CASE# 25-5079 O COLLI COLLISION TIME
OF 06/10/25 15:12
COLLI
NARRATIVE
CC 25-5079
On 6/10/2025 at 1514 hours I was dispatched to a motor vehicle collision at around the 100 block of
Rainier Ave S in the City of Renton, King County, Washington.
Pre-Collision
Driver 1 stated that she was traveling North on Rainier Ave S in the #2 lane approaching the 100
block.
Pedestrian 1 stated that he was walking from West to East across Rainier Ave S at around the 100
block. Pedestrian 1 was not within a marked crosswalk.
Collision
Driver 1 stated that as she entered the 100 block, Pedestrian 1 emerged from the Southbound lanes
of travel and she did not have time to stop or slow to avoid a collision. Driver 1 stated that the drivers
side mirror and door collided with Pedestrian 1 who was forced to the ground by the impact.
Pedestrian 1 stated that as he exited the Southbound lanes of travel and into the #2 lane of
Northbound Rainier Ave S, he did not see Unit 1 and the drivers side mirror and door struck
Pedestrian 1 and forced him to the ground.
Injuries
Pedestrian 1 complained of left foot pain and was medically transported to Valley Medical Center for
further evaluation.
Vehicle Disposition
Unit 1 was operational.
Proximate Cause
I determined that Pedestrian 1 is the proximate cause of this collision because Every pedestrian or
personal delivery device crossing a roadway at any point other than within a marked crosswalk or
within an unmarked crosswalk at an intersection shall yield the right-of-way to all vehicles upon the
roadway.
A written warning was sent to Pedestrian 1 per RCW 46.61.240.
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 16:28 on 6/10/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO.'; EGO1271 CASE# 25-5079 DATE AND TIME i 06/10/25 15:12
OF COLLISION
NIER AVE ,
k
I �
1 �
w
i
3 S
h t
�$4
l
s
s
tax �
h1 t 3
}
� q
PAGE 4 OF 4