HomeMy WebLinkAbout25-4490 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG01891oc� RA
COLLISION REPORT 1591971
CASE# 25-4490 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCCO A`GENC'Y 4200 3
COUNTY RD NVOLVED CODING
2 PRIVATE WAY
❑ 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 - 22 - 2025 1151 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
N SOUTH PORT DR
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ MILES�. FEET e S 8 E e LAKE WASHINGTON BLVD
0 4 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES NO F/ D:2067569004 Q 1 30
5❑ LAST NAME DEBEB FIRST NAME ASHENAFI MIDDLE B 1 2 31
INITIAL
STREET ❑ 820 YESLER WAY UNIT 507 CITY SEATTLE ST WA ZIP 981045106 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKYEs N ✓ YES NO✓
8� LICIENS# STATE WA SEx M MMOCSYY' 10 1 2 32
9� ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CFV2020 STATE WA VN# 5J6RT6H50NL057705 3
10 PI ATF#
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TRLR 3 5 33
12 3 5 VIN# VN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT VEHICLE
13 4 2022 HOND CR-V 4H DAMAGE vesNo ✓ ves❑ No✓ 3 7 34
REGISTERED OWNER INFO ASHENAFIDEBEB 1823 E MADISON STAPTB407 SEATTLE WA 98122 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 ✓ STATE FARM 5296300F0747
IN EFFECT &POLICY# 4TOP
vEnic�E CHARGE I 5 36
LEGALLY YES❑NO❑ CITATION# 7 0 80TTOM
15❑ STM ING
MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE' ❑ ❑ nWNER YEs,/ No D:3146042968
16�
LAST NAME CORBETT FIRST NAME AUTUMN MIDDLE I R
INITIAL
STREET ❑ 37
17 '❑ 5026 22ND AVE NE APT 3 CITY SEATTLE ST, WA ZIP 981055729 4
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED+ 38
INTERLOCKYEs No✓ INTERLOCK YES No✓ res No✓
19� DRIVER'S STATE WA SEX F D.O.B. 02 27 1999 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H UET 2 SE CLA 1 Y NATURE OF INJURIES 40
21 LICENSE CKE7159 TATE WA VIN# SHSRD78894U234474 � 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2QQ4 MAKE HOND MODEL CR-V STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO AUTUMNCORBETT502622NDAVENEAPT3 SEATTLEWA98105 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 988231352
IN EFFECT &POLICY# 9TOP
VEHICLE LEGALLY ❑ N`,.ILJ
—I CITATION CHARGE 1060TTOM
25 YES a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.CHANG 10065 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EGO1891
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4490
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER WITNESS 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
RTF
On 05-22-2025 at about 1204 hours, I was dispatched to a collision which occurred at the intersection
of N South Port Dr and Lake Washington Blvd N, with in the City of Renton, King County,
Washington.
Upon arrival I saw a panel cover in front of lane 2 of west bound N South Port Dr. I directed both
drivers to pull off the road so they would not be blocking traffic.
Driver of unit 1 believed he and unit 2 were in the far-left turn lane on N South Port drive. He was
making a left turn onto Garden Ave N. The other to his left was going straight. Driver of unit 1
believed the other vehicle should be making a left turn.
I spoke with the driver of unit 2 and she said she was in lane 2 west bound which goes straight. She
said the other vehicle was in lane 1 which goes straight. Unit 1 merged into her lane colliding with
her.
Unit 2's account matches the debris I saw in lane 2.
1 check under both vehicles and saw only unit 2 was missing the front plastic panel.
Driver of unit 1 said he was driving around with no destination. He was waiting for a fair. Driver of
unit 2 said she was going to Papaya restaurant and following her GPS.
Unit 2 said driver of unit 1 wanted to exchange information and not have police involved.
This incident is only a summary of what occurred and was captured on my body camera.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 05-22-25 02:44 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
J.TRADER 4553 DAT 6/18/2025 10:43:12 AM
BADGE OR ID# 10065 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 11:51 AM TIME POLICE ARRIVED 12:07 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EGO1891 CASE# 25-4490 DATE AND TIME 05/22/25 11:51
OF COLLISION
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