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Home My WebLink About25-4872 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG01892oc� RA COLLISION REPORT 1591971 CASE# 25-4872 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOt'ALNENO'Y. 4200 3 COUNTY RD INVOLVED CODING PRIVATE WAY 2❑ TRIBAL TOTAL OBJECT 1UNITS#OF 02 TRUCK 1 0 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coulsloN' 06 - 04 - 2025 1511 17 =.= S 8 W e IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ N 4TH ST BLOCK NO. e 1000 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------�.� FEET H S 8 W e PARKAVEN 0 4 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHON UNIT 01 E VEHICLE ❑ CYCLE ❑ YES No �/ D:9139528006 0 4 30 5 LAST NAME AVEY FIRST NAME KENNARD MIDDLE L 1 1 2 31 INITIAL STREET ❑ 1108 GAYLER ST CITY MOUNTAIN VIEW ST AR ZIP 72560 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs[:].OR] INTERLOCKYEs NO�/ YES R NOF,/ g❑ DCIENS STATE AR SEX M MMDCSYY' 04 — O6 — 1947 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 LICENSE NO PLATE srarE WA vN 1x 1XKWD49XORR268016 3 TRAILER STATE TRAILER ,STATE 11 3 5 PLATE# PLATE# FROM TO TRLR TRLR 3 5 33 12 3 5 VIN# vI. ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 3 5 34 13 2 2024 KEN W900 SE DAMAGE YES DNO YES❑ NO REGISTERED OWNER INFO PACCAR INC 777106TH AVE NE BELLEVUE WA 98004 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 LIABILITY INSURANCE❑ INSURANCE CO 2 3 4 14 ACORD MR-4A355786 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE t 5 36 Lemur YES❑NO❑ CITATION# 7 0 80TTOM 15❑ nNowc e MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE VEHICLE UNIT 02 CYCLE (7WNPR Q ❑ PEDESTRIAN ❑ D:2064341066 YES NO 16� LAST NAME BECKERMAN FIRST NAME RICHARD MIDDLE I A INITIAL 2 STREET ❑ 17 ❑ 510 FORSYTH LN,UNIT 301 CITY I EDMONDS ST, WA ZIP 98020 4 37 NEW ADDRESS 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYEs NO INTERLOCK YES No vEs NO 19[—] DRIVER'S STATE WA SEX M I D.O.E. 11 27 1955 39 LICENSE# MMDDYY — 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H UET 2 SE CLAY 1 NATURE OF INJURIES 40 21 SS LICENSLATE# ASL1672 rarE WA vIN# 4T1BD1FK3EU114503 41 22❑ STATE TILER PATE# STATE ❑ 42 PLATE# 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2014 MAKE TOYT MODEL CAMRY STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO [NEW] VEHICLE NO,2 SHADE DAGAREA LIABILITY INSURANCE INSURANCECO AMERICAN FAMILY BX11768342 IN EFFECT &POLICY# t STOP 5 vewae ❑ CITATION 11 CHARGE t080TTOM LEGn,v YES N J 25 s 7 a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 T.NELSON 12327 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EGO1892 COLLISION REPORT III III III III III 111 1591972 CASE# 25-4872 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. T.NELSON 06-04-25 04:59 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE J.TRADER 4553 6/18/2025 10:41:37 AM BADGE OR ID# 12327 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:12 PM TIME POLICE ARRIVED 3:30 PM PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 57 REPORT NO.` EGO1892 CASE# 25-4872 O COLLI COLLISION TIME OF 06/04/25 15:11 COLLI NARRATIVE 25-4872 Unless otherwise noted, the following occurred in the City of Renton, County of King, WA. I arrived and located the involved units. Unit 1 had sustained damage to the front driver side of the bumper. Unit 2 had sustained significant passenger side damage. The driver of unit 1, Avey, advised that he was travelling westbound on N 4th St in lane 2 and attempted to make a left turn onto southbound lane 1 of Park AVE N. As unit 1 turned, the front driver side bumper struck the passenger side of unit 2 in lane 1. The driver of unit 2, Beckerman, advised that he was travelling westbound on N 4th St in lane 1 and attempted to make a left turn onto southbound lane 1 of Park AVE N. As unit 2 turned, the passenger side was struck by unit 1. I facilitated an exchange of information between the involved parties. Ultimately, I am led to believe that unit 2 had the right of way and that unit 1 ultimately had the responsibility to make sure they were clear to make the turn, however the fact that unit 1 is a semi- truck known for making wide turns creates ambiguity as to which driver's actions were the proximate cause of the collision. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by T. Nelson 12327 on 06-04-2025 at 1613 hours in Renton, WA. PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EGO1 892POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 25-4872 1 COMMERCIAL MOTOR CARRIER INTERSTATE ✓ INTRASTATE UNIT# 1 USDOT ICC# VEHICLE TYPE 2 1 CARGO BODY 9 TYPE 2 ❑ 1 28 CARRIER NAME. PACCAR 1NC 3 CARRIER L ADDRESS 777 106TH AVE NE CITY BELLEVUE ST WA ZIP 98004 4 NAME I I # PLACARD -� NAME IF NO NUMBER SOURCE' 3 AXLES 03 GwuR 53200 + 4a ❑ ADDITIONAL UNITS 5 VEHICLE CYCLE PEDESTRIAN OWNER YES O MOTOR ❑ CI PROPERTY ❑ DAMAGE THRESHOLDMET PHONE ❑ UNIT# MIDDLE; 29 LAST NAME FIRST NAME INITIAL STREET 30 NFW ADDRFS. CITY ST ZIP 6 1 PRESENT MEDICAL TANSPORTED 1 31 CDL IGNITION REQUIRED IGNITION INTERLOCK YES NO INTERLOCK YES NO YES N G LICENSE STATE SEX MDDYB -C-1 7 ON DUTY STATUS: AIRBAG RESTR. EJECT HELMET INJURY NAruftEoflNJURIEs USE GLASS 8 ❑ #LICNSE VIN 1 32 PLATE# TAT 9 TRAILER TRAILER 2 PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.# VIN.#. 11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWE E T ABLIN TOWED BY GOVT.VPHICI F FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 � SHADE IN DAMAGED AREA 4 FROM TO LIABILITY INSURANCE❑ INSURANCE CO 7t)P IN EFFECT &POLICY# 34 13 YES NO CITATION# CHARGE 1080TTC7M ecauv DAMAGE THRESHOLD MET PHONE 35 sTnNoiNc MOTOR PEDAL_ ' PROPERTY 1:1 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 15 LAST NAME FIRST NAME ❑INITMIDDL ALE 36 16 ❑ STREET CITY ST ZIP NEW ADDRESS" GDL IGNITION RE(]UIRED IGNITION PRESENT MEI7ICALTANSPORTED INTERLOCK YES NO INTERLOCK VES NO .YES NO 17 37 DRIVERS STATE SEX M�DDWY 18 ❑ HELMET INJURY NATURE OF INJURIES 38 ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS 19 ❑ ❑ 39 LICENSE viN PLATE# TAT # 20 ❑ TRAILER TRAILER ❑ 40 PLATE#. STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN#1 VIN#; 42 22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT I &POLICY# tK-99 5 44 vewc�e ❑ ❑ CITATION# CHARGE 24 IEG_ VES NOSTIWDING6 3 6 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. T.NELSON 06-04-25 04:59 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 BADGE OR ID# 12327 O#RI WA0171300 APTRADER 61118/2025 PAGE�OF 3000-345-013(R 11/18) REPORT NO. EGO1892 CASE# 25-4872 DATE AND TIME i 06/04/25 15:11 OF COLLISION } r 4 t k 34 �t r t k 3 F +aft 33`N t t it s 4 i try PAGE 5 OF 5