HomeMy WebLinkAbout25-5880 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG09905OLCERA
COLLISION REPORT 1591971
CASE�# 25-5880 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL INENO'Y'. 4200 3
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL 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#
LOLL s onr 07 - 07 - 2025 0705 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
S 43RD ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�. FEET H S 8 W e TALBOT RD S
0 6 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4255259703 0 6 30
6 LAST NAME IBRAHIMI FIRST NAME AHMAD MIDDLE M 1 2 31
INITIAL
STREET ❑ 20605 108TH AVE SE APT 21 CITY KENT ST WA ZIP 980311584 2
NEW ADDRESS
7 +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No INTERLOCKYEs NO YES F NO
8 DCIENS STATE WA SEX M MMorYY' 01 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET CLASS 1 NAruRE of INJURIES 2
LICENSE, CPB9992 STATE WA VN# 4T1BF1FK6HU693016 3
10 PI ATP rt
TRAILER STATE TRAILER ..STATE
11 3 5 PLATE# PLATE# ROM TO
TRLR TRLR 3 7 33
1 3
( FROM TO
2 5 VIN# vI.
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 4 2017 TOYT CAMRY DAMAGE YES DNO ✓ YEs❑ No 3 7 34
REGISTERED OWNER INFO OWNEDBYDR/VER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 NSURANCE CO 3 4
14 LIABILITY INSURANCE❑ PACIFIC STAR 5549455
IN EFFECT &POLICY# 4TOP 5
VEHICLE CHARGE 7 o BOTTOM 36
15
srnNoiNc YES❑NO❑ CITATION# 5A0625687,5AO625687 FOLLOW VEHICLE TOO CLOSELY,OP B 7 e
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
VEHICLE
UNIT 02 CYCLE (7WNPR Q ❑ PEDESTRIAN ❑ D:2069736026
YES NO
16�
LAST NAME DUMAS FIRST NAME ROBIN MIDDLE' M
17 F1 INITIAL I
STREET ❑ 37
'NEW ADDRESS❑ 2300 BENSON RD S UNIT H3 CITY I RENTON ST, WA ZIP 980558879
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES No INTERLOCK YES 0No YEs No
19 DRIVER' #
INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E BRY2859 TATE WA vIN# 2GKFLTEKXG6352568 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q16 MAKE GIyIC MODEL TERRAIN STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 3377393-D23.474
IN EFFECT &POLICY# t 9TOP
veeiae ❑ ,J—I CITATION# CHARGE tO BOTTOM
LecnLLY YES N`.LJ
25 s 7 a
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. EG09905
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5880
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 07-07-25 01:03 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/15/2025 1:48:27 PM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 7:06 AM TIME POLICE ARRIVED 7:12 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT No.` EG09905 CASE# 25-5880 O COLLI COLLISION TIME
OF 07/07/25 07:05
COLLI
NARRATIVE
CC 25-5880
On 7/7/2025 at 0706 hours I was dispatched to a motor vehicle collision at the intersection of Talbot
Rd S and S 43rd St in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was traveling West on S 43rd St just past the intersection of Talbot Rd S in
the #3 lane. Driver 2 stated that she was coming to a stop for traffic stopped ahead of her.
Driver 1 stated that he was behind Unit 2 proceeding West on S 43rd St at Talbot Rd S in the #3 lane.
Collision
Driver 2 stated that as she was coming to a stop of traffic, she felt a jolt and advised that the front
bumper of Unit 1 collided with the rear bumper of Unit 2.
Driver 1 stated that he was attempting to slow down but was unable to do so in time to avoid a
collision. Driver 1 stated that he saw Unit 2 coming to a stop and pressed his brakes. Driver 1 stated
that the front bumper of Unit 1 collided with the rear bumper of Unit 2.
Injuries
None reported.
Vehicle Disposition
Unit 2 sustained minor damage and was operable. Unit 2 sustained heavy damage but was able to
drive off of the roadway and did not require a tow.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because the driver of a motor
vehicle shall not follow another vehicle more closely than is reasonable and prudent, having due
regard for the speed of such vehicles and the traffic upon and the condition of the highway. Had
Driver 1 been following at a distance that was reasonable and prudent given the prevailing traffic
conditions, this collision would not have happened.
Driver 1 was also unable to provide me with valid insurance for his vehicle. I gave him until 1100
hours to email me with proof of insurance and still had not received the necessary documents at
1300.
Driver 1 was cited per RCW 46.61.145 and RCW 46.30.020.
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 08:38 on 7/7/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG09905 CASE# 25-5880 DATE AND TIME 07/07/25 07:05
OF COLLISION
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