HomeMy WebLinkAbout25-5913 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG09290OLCERA
COLLISION REPORT 1591971
ASE#I 25-5913 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4100 3
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL UNITS#OF 03 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' 07 - 08 - 2025 1233 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
NE 3RD ST BLOCK NO. e 2300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e✓ S 8 W e BLAINE AVE NE
0 1 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES V,No D:4253198845 0 6 30
5 LAST NAME JOHNSON FIRST NAME ELIJAH MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 1702 E 57TH ST CITY TACOMA ST WA ZIP 984044427 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES D NO✓
8❑ DRIVERCENS # STATE WA SEX M MMDr YY' 12 - 20 - 2005 1 2 32
9 ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of IN Ts 2
USE ;CLASS AIRBAG BURN TO LEFT FOREARM/WRIST
10 9 LI ENS ATFuE! BBY9117 STATE WA VN# 19XFB2F53DE257783 3
11[-j- TRAILER STATE TRAILER ,STATE ROM To
11 3 5 PLATE# PLATE#
TRLR TRLR 3 7 33
12 3 5 VIN# vI.
( FROM TO
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN GOVT VEHICLE 3 7 34
13 4 2013 HOND CIVIC p4 DAMAGE YES ONO IMWI&RS TOWING YEs_ No✓
REGISTERED OWNER INFO LINDSEYBOUNLEURT1702E57THST TACOMA WA98404 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3
14❑ LIABILITY INSURANCE� INSURANCE CO ALLSTATE 979445560 4
IN EFFECT &POLICY# 4TOP _
srgNOLNG Yes❑NO❑ CITATION# 5A0563866 CHARGE INATTENTIVE DRIVING o ooTrob 36
15
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT OZ Q ❑ PEDESTRIAN ❑ D:4259997324
VEHICLE CYCLE (7WNFR YES✓ NO
16�
LAST NAME SIMMONS FIRST NAME KOBI MIDDLE M
INITIAL
STREET ❑ 37
17 ❑ 4215 NE 5TH ST CITY RENTON ST, yyq ZIP 980594709 4
NEW ADORE SS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED+ 38
INTERLOCKYES NO✓ NTERLOCKYES No✓ YES No'✓
19 DRIVER'S STATE WA SEXI F D.O.B. 09 22 1998 39
LICENSE# MD.02. —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H UET 2 CLAY 1 NATURE OF INJURIES 40
SE SS
21 LICENSE BLL6144 TATE WA VIN# KMHTC6AD1GU301125 � 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2016 MAKE HYUN MODEL VELOSTE STYLE p4 VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO .13ISIMMONS 4215NE 5THST RENTON WA 980594709 D:4259997324 VEHICLE NO.2
SHADEDAMAGAREA
3
LIABILITY INSURANCE INSURANCE CO STATE FARM 5562317C23474001
IN EFFECT &POLICY# 9TOP
HICLAIL YES❑ N CL J CITATION# CHARGE t080TTOM
VEE
M
25 --J
'
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
D.NELSON 12421 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG09290
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5913
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME SIMMONS MEKHI A
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE# DOB
4215 NE 5TH ST RENTON WA 980594709 4259997325 SEX' M MMDDYYYY 06 - 17 - 2004
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
2 POS. 3 2 4 1 USE 2 CLASS 11 ---�
'NAME
LAsr F RST,MIDDLE INITIAL) MARTIN JAMES O
ADDRESS&PHONE# D(�B
449 SHELTON PL NE RENTON WA 980568553 4252239173 SEX M MMDDYVYv 10 _ 02 _ 1947
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER �WITNESS UNIT# i 3 P S 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME MIDDLE INITIAL) MARTIN WOLSUN N
',(LAST,FIRST,
ADDRESS&PHONE# 449 SHELTON PL NE RENTON WA 980568553 4252239173 SEX'. F D.O.B. 10 _ 02 _ 1958
MMDDYYYY
PASSENGER Z WITNESS UNIT# 3 SEAT 9 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES
QI. POS. USE 'GLASS COMPLAINT OF HEAD/NECK PAIN
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.
D.NELSON 07-08-25 02:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
M.LEVERTON 2517 7/9/2025 3:16:20 PM
BADGE OR ID# 12421 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 12:36 PM TIME POLICE ARRIVED 12:37 PM
PART B 3oDo-345-,aR(Burls) PAGE 27 OF 57
REPORT NO.` EG09290 CASE# 25-5913 O COLLI COLLISION TIME
OF 07/08/25 12:33
COLLI
NARRATIVE
25-5913 ACCINP
On 7/8/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a blocking collision near the intersection of Blaine Ave
NE and NE 3rd St Renton/King/WA. Sgt Woodward was first on scene and advised that he needed
one tow and RRFA for head/neck injuries.
I arrived on scene and located Officer Catalan who had obtained all information from the involved
parties. Officer Catalan informed me of the following:
Vehicle 1, a 2013 Honda Civic WABBY9117, driven by Elijah C Johnson DOB: 12/20/2005 (confirmed
by WADL), was driving in the #2 lane west on NE 3rd St. Traffic ahead of him was stopped and
slowing and Elijah failed to see it and collided with Vehicle 2. There was front airbag deployment in
the Honda and Elijah had a small airbag burn on his left wrist, he was evaluated by RRFA and
cleared at the scene. The Honda had extensive damage to the front end and had to be removed from
the scene by Bankers Towing.
Vehicle 2, a 2016 Hyundai Veloster WA/BLL6114, driven by Kobi M Simmons DOB: 9/22/1998
(confirmed by WADL) was driving in the #2 lane west on NE 3rd St. The Veloster was slowing for a
stopped vehicle in front of it when Vehicle 1 collided with its rear bumper and pushed it into Vehicle 3.
Neither Kobi nor her passenger were injured. The Veloster had extensive front and rear end damage
but was able to leave the scene, airbags did not deploy in the Veloster. Kobi and her passenger were
evaluated by RRFA and cleared at the scene.
Vehicle 3, a 2022 Hyundai Tucson WA/BZY4691, driven by Brian J Martin DOB: 4/18/2003
(confirmed by WADL) was stopped for a vehicle in front of it in the #2 lane facing west. Vehicle 2 was
pushed into Vehicle 3 and caused minor damage to the rear bumper. Neither Brian nor his front seat
passenger were injured, the rear passenger, identified by her WADL as Wolsun Martin DOB:
10/2/1958 had a complaint of head and neck pain from the collision. Wolsun was evaluated by RRFA
at the scene and cleared. No airbags deployed inside the Tucson, and it was able to leave the scene.
Based on Elijah failing to yield to stopped and slowing traffic in front of him I completed Sector citation
#5A0563866 for RMC10-12-25 Inattentive Driving. This citation should be mailed to Elijah at his DOL
address.
The definition of Inattentive driving is as follows:
10-12-25 INATTENTIVE DRIVING:
It shall be a traffic infraction, subject to RCW 7.80.120(1)(a), for any person to drive a motor vehicle
on any public highway, street, alley, or road in an inattentive manner in the City of Renton.
"Inattentive manner" in this section means a lack of: 1) attentiveness required to safely operate the
vehicle under the prevailing conditions, including, but not limited to, the nature and condition of the
roadway, the weather conditions, the presence of pedestrians, the presence of other traffic, or by the
driver focusing or directing the driver's attention to something other than driving the motor vehicle; or
2) attentiveness that would permit the driver of a motor vehicle to observe anything resting on, or
traveling on, or entering the roadway in time to take appropriate action as circumstances require.
(Ord. 4462, 7-25-94, eff. retroactive to 7-1-94; Ord. 5635, 11-14-11)
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 7/8/2025 Renton WA
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EG09290
POLICE TRAFFIC
1 1 8 27
µ ^'� COLLISION REPORT CASE#+ 25-5913
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 NAME # PLACARD.
OWUR NO NUMBER
SOURCE' AXLES1:1 + NAME IF
4a ❑ ADDITIONAL UNITS
'J ,µ MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ UNIT# 3 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑'. YES NO
D:4252239173
0 7 29
FIRST NAME MIDDLE
LAST NAME MARTIN BRIAN INITIAL J
STREET 30
S.,P 449 SHELTON PL NE CITY RENTON ST WA ZJP 980568553
6 [2NFW ADnRF 1 1 2 31
CDL IGNITION REQUIRED IlGNi710N PRESEN7 MEDICALTANSPORTED'.
INTERLOCK YES NO „INTERLOCK YES NO YES NZ
DRIVER'S STATE WA SEX M D.O.B
7
LICENSE MMDDVY04 - 18 - 2003
ON DUTY STATUS: AIRBAG 2 RESTR. ¢ EJECT g HELMET 2 INJURY 1 NAruREofINJURIES
USE ..GLASS...:
LICENSE BZY4691 TAT WA VIN# 5NMJBCAE4NH020849
PLATE#
9 2 TRAILER I TRAILER
PLATE#r STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.#. VIN.#.
11 2 5 VEH.YEAR2022 MAKE HYUN MODELTUCSON I STYLE P4 VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO
DAMAGE YES NO ✓ YES NO
DAMES MARTIN 449 SHELTON PL NE RENTON WA 980568553 D:4252239173 9 9 33
REGISTERED OWNER INFO. SHADE IN DAMAGED AREA
12
FROM TO
ZI INSURANCE CO
LIABILITY INSURANCE GEICO 0224336707
IN EFFECT &POLICY# i T ___ m 34
13 vewcEe YES 11001CITATION# CHARGE ecauv
sTANoINc � 3 7
MOTOR PEDAL_ ' PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
15 LAST NAME FIRST NAME INITIAL E
❑ 36
16 ❑ STREET CITY ST! ZIP
NEW ADDRESS"
GDL IGNITIC7N REOUIRED IGNITION PRESENT MEl71CAL TANSPORTED.
INTERLOCK YES NO INTERLOCK YES NO YES NO
17 4 37
RIVERSLICENSED
LIICENSE SEX Mmp -� II
18 ❑
HELMET INJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ LICENSE TAT VIN# 39
PLATE#
20 ❑ TRAILER TRAILER ❑ 40
PLATE#. STATE PLATE# STATE
21 ❑ ❑ 41
TRLR TRLR
VIN#�. 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 &POLICY# t.K-99
5 44
vFHICEE ❑ ❑ CITATION# CHARGE 24 IEGALLY VES NO3 3 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.NELSON 07-08-25 02:03 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 12421 O#RI WA0171300 APLEVERTON 71912025 PAGE OFF
3000-345-013(R 11l18)
REPORT NO. EG09290 CASE# 25-5913 DATE AND TIME i 07/08/25 12:33
OF COLLISION
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