HomeMy WebLinkAbout25-5412 ("7—
STATE.w,-" .:.. TcN 1 27cRaFFi O EG02792
,one COLLISION REP F 1591971
CASE# 25-5412 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
STOLEN
1 2 STATE ROUTE OTHER VFHICI F LOCAL AGENCY 4200 3[�
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TRIBAL UN 75 TOTAL#OF STRUCK OBJECT 11 8 2$
RESERVATION 2
3 M M D D Y Y Y Y TIME I2400) COUNTY# MILES CITY#
coAT sloN 06 - 21 - 2025 1445 17 a. e W 8 OF IN 8 1070 3
S
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NONINTERSECTION ❑
NE 12 STREET BLOCK NO. 8✓ 1200 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ FEET e S e E 8 HARRINGTON AVE NE
OF 6 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE EA HE
NG �/ D:4258663125 0 8 30
6 LAST NAME WELLMAN SANTOS FIRST NAME EVAN MIDDLE M 0 4 31
INITIAL
STREET E' 1409 MONROE AVE NE CITY RENTON WA
NEW ADDRESS S7 ZIP 98056 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES LINOZINTERLOCK YES[:]No W YES NOW
8❑ LICENSE# STATE y�/A SEX'M MM flYY 08 - 02 - 2006 1 2 32
9 F] ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U5 E7 2 CLASS 1 NATURE OF INJURIES 2
LIC NSE CLG3314 STATE
WA WIN# 1J4GK48K26W113812 3
10 2❑ 1 PI
11 3 0 PLATE# STATE PLATRAITE# STATE FROM -
TRLR TRLR. 1 7 33
12 3 0 VIN#' VIN#
FROM TO
VEH,YEAR 2008 MAKE JEEP MODEL LIBERT STYLE P4 VEHICLE TOWED TO BLIN TOWED BY GOVT,VEHICLE g 9 34
13 DAMAGE YES No ✓ YES❑ 1NO
REGISTERED OWNER INFO PEDRO SANTOS SALMERON 1409 MONROE AVE NE RENTON WA 98056 D:4254356733 VEHICLE NO. 1 ❑
SHADE 1N DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO 4
IN EFFECT &POLICY# 9TOP
VtwCLt CHARGE 5 ❑ 36
LEGAL v YES[:]NO[:] CITATION# III
15❑ --NG a 7 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE OWNER YES NO D:2063342888
16�
LAST NAME AHL FIRSTNAME OlIVIA MIDDLE' D
INITIAL
17❑ STREET El 3515 NE 10 PL CITY RENTON I ST', WA I ZIP 98056 4
NEW ADDRESS ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION pRESEIJT MEDfCALTRANSPORTED 38
W7ERLOCKvEs ND INTERLOCkCvEs no ves No,�
19 DRIVER'#
ON DUTY STATUS AIRBAG!2 RESTR 4 EJECT 1 H U E7 2 INJURY 1 NATURE of INJURIES 40
❑21❑ LICENSE BXV2835 TATf'WA vIN# 1N4BL2AP4AC111051 41
1
PLATE#
42
22 PLATE#TRAILER STATE PLATE TRAILER STATE
23 43
TRLR RLR
VIN#. '[N#,
VEH.YEAR 2010 MAKE /I//SS MODEL ALT/MA STYLE P4 DAMIAGE TOWED NOO✓ BLIN TOWED BY GO YES N HI 44
O
24 YES
REGISTERED OWNER INFO OWNED BYDRIVER VEHICLE NQ.2
SHADE IN DAMAGAREA
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 922338117 2 3
IN EFFECT &POLICY# t 4TOP
VFHC YES� N 1—
CITATION# CHARGE
25 �� . J tOBOTTQM
s 7 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
DES/REE SCOTT 10272 WA0171300
PARTA 9000-345-159. (R 11(181 PAGE 01 OF
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG02792
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5412
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS❑;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES
POS. ' USE CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. -
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. I USE CLASS
NARRATIVE
On 6/21/25 around 1447 hours I was dispatched to the intrsection of NE 12th ST and Harrington AVE
NE (City of Renton, County of King, and State of Washington) due to a report of a vechile collison.
Upon arrival I contacted driver#1 who stated that he has worn tires in vehicle #1 and when he tried to
stop he slid into vehicle #2 that was stopped at the stop sign. I asked how fast he was going when he
collied with Vehicle #2. Driver#1 said he was going about 10-15 miles per hour at time of impact as
he was unable to stop with the rain, wet roads and bald tires. Driver#2 stated she was facing
Westbound and stopped at the stop sign at a complete stop when she was struck from behind from
Vehicle #1. Vehicle #2 had damage to its rear bumper, scratches and a small dent. Vehicle #1 had
damage to its front bumper, however it had previous damage to it, but Driver#1 stated there were
new scratches. No injuries reported.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
DESIREE SCOTT 06-21-25 04:19 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVEQ BY DATE
DESIREE SCOTT 10272 6/21/2025 4:24:23 PM
BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:48 Pry/ TIME POLICE ARRIVED i 2:55 PM
PART B 3000-345.160(R1Vt8) PAGE F2 --]OF F3
REPORT NO. EG02792 CASE# 25-5412 DATE AND TIME 06/21/2514:45
OF COLLISION
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