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HomeMy WebLinkAbout25-5436 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG04043OLCERA COLLISION REPORT 1591971 CASE# 25-5436 2 INTERSTATE CITY STREET FIRE I RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4100 3 COUNTY RD NT&RUN ©DING PRIVATE WAY 2 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 02 STRUCK FENCE RESERVATION : 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCL s on' 06 - 22 - 2025 1715 17 =.[� S e W e OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. LOAGAN AVE S 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 MILES 1.1 FEET e S 8 W e S TOBIN ST 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2065031932 0 4 30 6 LAST NAME MCCLAIN FIRST NAME CHRISTIAN MIDDLE D 1 1 2 31 INITIAL STREET ] 11149 203RD PL SE CITY; KENT ST WA ZIP; 980315567 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs No✓ INTERLOCKVEs NO✓ YEs NO✓ 8❑ DCIENSE# STATE WA SEXI M MMDDYY' 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASSY ? [NATURE of INJURIES 2 LICENSE, CAL5039 STATE WA VIN# JN8AY2NC4H9503134 3 10 Fq I PI ATP tt TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR rRLR. 5 1 33 12 0 0 VIN#' vIN# FROM TO VERYEAR 2017 MAKE NISS MODEL ARMAD STYLE UT V Y EHICLE TOWED TO BLIN TOWED By GOVT V rj 7 EHICLE 34 13� DAMAGE YES II_II NO ✓ YESII_I) NO REGISTERED OWNER INFO REBECCA JOYCE 11119203RD PL SE KENT WA 98031 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 4 14 PERMANENT GENERAL 53-WA-4449322 IN EFFECT &POLICY# 9TOP CHARGE 5 36 Lemur yes❑NO❑ CITATION# t a BOTTOM 15❑ STANDING B 7 6 MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR D:2066020433 16� LAST NAME DONALDSON FIRST NAME DEAN MIDDLE C INITIAL 17 STREET ❑ 15300 SE 155TH PL UNIT D306 CITY' RENTON ST, WA ZIP 9805883 37 19 4 NEW ADDRESS ❑ 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYEs No✓ INTERLOCK YEs No✓ vEs No✓ 19 DRIVER'S STATE WA SEX M I D.Os. 05 - 26 ?965 39 LICENSE# MMDDYY — 20❑ ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40 USE CLASS LEFT SHOULDER HIP AND SIDE PAIN NECKPAIN 21[ LICENSE CNK5722 rarE WA vIN# 19XZE4F53KE034219 41 22❑ PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# TOWED BY GOV HI 44 VEH.YEAR 2019 MAKE HOND MODEL INSIGHT STYLE DAMIAGE TOWED✓ No BLIN BANKERS ves No✓ 24 REGISTERED OWNER INFO DEAN DONALDSON 15300 SE 155TH PL UNIT D306 RENTON WA 98058 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO STATEFARM 526-3464-Dll-47 IN EFFECT &POLICY# 1�wl veG— ❑ , CITATION# CHARGE LEGALLY YES N`[ 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEVIN PETERSON 12808 WA0171300 PAGE 01 OF PART A 3000-348-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG04043 COLLISION REPORT III III III III III 111 1591972 CASE# 25-5436 E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) M (LAST,FIRST,MIDDLE INITIAL) JACKSON D'MAUGHN C ADDRESS&PHONE# 1923 TALBOT RD S RENTON WA 98055 SEXi M MMDDD BYYY 02 - 16 - 2006 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURECFINJURIES z 1 1 POS. 9 2 4 1 USE 2 CLASS 1 ----� :NAME Lnsr EIRST,MIDDLE INITIAL) i JACKSON DAVEAUGHN A ADDRESS R PHONE# 1923 TALBOT RD S RENTON WA 98055 SEX' M D O,e• 08 _ 09 _ 2007 MMDDYYYY SEAT HELMET NJURY NATURE OF INJURIES PASSENGER a WITNESS UNIT# 1 POS. ' 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 ----� NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX/ D.O.B. - MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURECFINJURIES POS. I USE CLASS NARRATIVE I was dispatched to a collision on 06/22/25 at 1716 hours at Logan Ave S and S Tobin St, in city Renton, King County WA. Unit 1 CAL5039 Driver: Christian D. Mcclain (DOB 02/19/2008) Unit 2 CNK5722 Driver: Dean C. Donaldson (DOB 05/26/1965) Upon arriving on scene, I could see Unit 2 in the fence of a resident on S Tobin St and Unit 1 on Logan Ave S. I spoke to Unit 2 who was still inside his vehicle and stated that he had neck pain as well as left shoulder hip and side pain. He told me he was traveling North on Logan Ave S when he tried to make a left turn on S Tobin ST. He said that when he begun to turn left Unit 1 then went into oncoming traffic and attempted to pass him smashing into him. Unit 2 stated that Unit 1 was speeding. I spoke to Unit 1's driver who told me he was driving North behind Unit 2 on Logan Ave S when Unit 2 suddenly stopped. Unit 1 stated that he then attempted to swerve into oncoming traffic lane to pass Unit 2 when suddenly Unit 2 took a left on S Tobin St. Unit 1 then collided with Unit two. All drivers of Unit 1 stated no injuries, and the driver of Unit 2 was transported to Valley Medical Center. Both drivers were given an information exchange with the case number as reference. Pictures were taken on scene and uploaded to evidence. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 06/22/2025, 2317 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 06-23-25 12:42 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 1 612512025 5:50:21 PM BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED 5:16 PM TIME POLICE ARRIVED i 5:20 PM PAST B 3 Da-3mx-attar(txIMR) PAGE 2�OF F3 REPORT NO. EG04043 CASE# 25-5436 DATE AND TIME 06/22/25 17:15 OF COLLISION tS t� h t �aY 4 55 } +t At Y s a t FF t ti ,y t � k s i t a` Y !'�2J YttFS St ^, Atli } l4i 1 t� � tF PAGE 3 OF 3