HomeMy WebLinkAbout25-5460 j ITFC II IIIII III IIIII II IIII IIIII I . 27I
OOLCERAF EG06254
COLLISION REPRT 1591971
CASE# 25-5460 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' 06 - 23 - 2025 1506 17 =.= S 8 W E IN OF M ?070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
SUNSET BLVD N BLOCK NO. e 400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
2 0 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES ✓NO D:9255482018 0 1 30
6 LAST NAME ARELLANES FIRST NAME TAYLOR MIDDLE L 1 2 31
INITIAL
STREET E1 14921 SE 177TH PL APT 23H CITY RENTON ST I WA Zip 9805890 11 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKYEs NO YES D No
8❑ LICIENS# STATE WA SEX F MMo YY' O6 - 25 - 1993 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS ? NAruRE of INJURIES 2
10 LI ENSE'ti�, BFY6346 STATE WA VN# 2T3JFREV7GW535912 3
11[-j- TRAILER STATE TRAILER STATE ROM To
11 3 5 PLATE# PLATE#
rRLR TRLR 1 5 33
12 3 5 VIN# vI.
'.....: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 2016 TOYT RAV4 DAMAGE YES�No ✓� ves_ No� 1 5 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE NSURANCE CO USAA 045108255R 3 4
IN EFFECT &POLICY#VEHICLE 4TOP _
srgNOLNG 5A0512695 CHARGE IMPROPER LANE USAGE s o ooTrofi 36
Yes NO CITATION#
15
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
VEHICLE
UNIT 02 CYCLE (7WNPR Q ❑ PEDESTRIAN ❑ D:4252800759
YES NO
16�
LAST NAME MYERS FIRST NAME MASON MIDDLE' M
INITIAL
17 F1 STREET �/ ❑
?116198THAVE E CITY LAKE TAPPS ST, WA ZIP 98391 37
NEW ADDRESS ':
18� CDL ... IGNITION REfiYUIRED IGNITION PRESENT MEDIGALTRANSP6RTED: 38
INTERLOCKYEs NO INTERLOCK YES ND YEs Nal
19 DRIVER'S STATE TX SEX M D.os. 05 29 ?984 ❑ 39
LICENSE# MMDDYY —
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY� STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ? ❑
21 LICENSLATE E MTR9927 rare TX VIN 1FTFW1ETXCKDO6374 41
22❑ PLATE# STATE PAAILER TE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q12 MAKE FORD MODEL F150 STYLE 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 USAA 0289734727104
IN EFFECT &POLICY# 9TOP
HiaE
CITATION 11
CHARGE
LvEeGnLLv YES❑ NLJ
25 t080TTOM
a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG06254
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5460
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.
C.ARNOLD 06-23-25 03:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/3/2025 8:55:09 AM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:08 PM TIME POLICE ARRIVED 3:47 Pry]
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG06254 CASE# 25-5460 O COLLI COLLISION TIME
OF 06/23/25 15:06
COLLI
NARRATIVE
CC 25-5460
On 6/23/2025 at 1508 hours I was dispatched to a motor vehicle collision at the 400 block of Sunset
Blvd N in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was proceeding South on Sunset Blvd N in the #3 lane approaching the 400
block having just exited from the Houser Way Bypass.
Driver 1 stated that she was traveling South on Sunset Blvd N in the #2 lane approaching the 400
block.
Collision
Driver 2 stated that as he entered the 400 block, Unit 1 began to merge from the #2 lane to the #3
lane. Driver 2 stated that in doing so he was unable to avoid a collision as Unit 1 merged in front of
him. Driver 2 stated that the front passenger side bumper of Unit 2 collided with the rear drivers side
door of Unit 1.
Driver 1 stated that as she merged left she did not see Unit 2 and the front passenger side bumper of
Unit 2 collided with the rear drivers side door of Unit 1.
Injuries
No injuries reported.
Vehicle Disposition
Unit 2 required a tow truck and was towed from the scene. Unit 1 was operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as
nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety.
Driver 1 was cited per RCW 46.61.140.
1 certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Arnold #12509 at 15:39 on 6/23/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG06254 CASE# 25-5460 DATE AND TIME i 06/23/25 15:06
OF COLLISION
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