HomeMy WebLinkAbout25-5182 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EGO1356oc� RA
COLLISION REPORT 1591971
CASE�# 25-5182 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL NENCY. 4200 3
COUNTY RD NVOLVED CODING
2 PRIVATE WAY
❑ TRIBAL TOTAL UN TS#OF 02 SOTRUCK 0 5 28
RESERVATION I 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 06 - 13 - 2025 1823 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION Z NON INTERSECTION ❑
NE 4TH ST BLOCK NO.
4a❑
MILE POST e
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET H S 8 W e NILEAVENE
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4258791908 0 4 30
6 LAST NAME LAWSON-SIMS FIRST NAME LESLIE MIDDLE A 1 1 2 31
INITIAL
STREET ❑ 17533 187TH PL SE CITY RENTON ST I WA ZIP 98058 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NOR] INTERLOCKYEs NO�/ YEs NO,/
8 DRIVECEN # STATE SEX F MMOS. 11 - 02 - 1979 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 I INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE'' 1908 STATE WA V(N# WAI2AAGE3MB000740 3
TRAILER STATE TRAILER ,STATE
11 0 0 PLATE# PLATE# ROM TO
TRLR TRLR 7 3 33
12 0 Q VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 3 5
34
13 4 2021 AUDI ETRON SD DAMAGE YES DNO YES❑ NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 3 4
14 FIRST NATIONAL H2O52943
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Ec LgLLY YES❑NO❑ CITATION# 70 80TTOM
15❑ sTnNowc 7 e
MOTOR PEDAL YES�/ NO PHONE
UNIT PEDESTRIAN PROPERTY D:20 VEHICLE CYCLE62917476 nWNFR
16�
LAST NAME NGUYEN FIRST NAME ALEXANDER MIDDLEI K
INITIAL
STREET ❑
17 ' 6❑ 152 NE 3RD CT CITY RENTON ST, WA ZIP 98059 4 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED (GNTION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYEs X YES NO YEs No;�
19 DRIVER'S STATE WA SEXI M D.O.B. 11 21 2001 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H UET 2 SE CLA1 Y NATURE OF INJURIES 40
SS
21 LICENSECPZ6730 TATE WA VIN# 5YJSAIE51SF548156 41
PLATE#
22❑ [TILER TRAILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2025 MAKE TESL MODEL MODELS STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO CONNECT AX01770419
IN EFFECT &POLICY# 9TOP
veeiae ❑ ,J—I CITATION# CHARGE t08OTTOM
LecnLLY YES N`[
25 N
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JASON TURNER 12650 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EGO1356
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5182
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME SIMS BRETT D
(LAST,FIRST,MIDDLE INITIAL}
ADDRESS&PHONE# DOB
17533 187TH PL SE RENTON WA 98058 SEX' M MMDDYYYY 02 — 21 — 1977
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z 1 POS. 3 2 4 1 USE 2 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 —F L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. USE CLASS r— ----�
NARRATIVE
Unit 1 was traveling eastbound on NE 4th ST approaching a greenlight at the cross street of Nile Ave
NE. Unit 2 was stopped at a flashing yellow left turn signal facing westbound. Unit 2 was set up turn
southbound on to Nile Ave NE. As Unit 1 proceeded through the intersection Unit 2 began their turn
causing the vehicles to collide in the intersection. Upon interviewing Unit 2 they admitted fault stating
that they failed to yield to Unit 1.
No injuries were reported from either vehicle.
Unit 1 had significant damage to the front of their vehicle. The vehicle was no longer capable of
driving so it was towed by Bankers Towing.
Unit 2 had minor damage to the front bumper of their vehicle and was capable of leaving the scene.
I created an exchange of information for both parties.
I determined that the proximate cause of the collision was Unit 2's failure to yield to Unit 1.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by J. Turner 12650 on 06/14/2025 at 0025 hours.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON TURNER 06-14-25 12:25 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 6/16/2025 8:11:53 PM
BADGE OR ID# 12650 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 7:23 PSI TIME POLICE ARRIVED 7:Y3 PM
PART IS 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO.'; EGO1356 CASE# 25-5182 DATE AND TIME 06/13/25 19:23
OF COLLISION
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