HomeMy WebLinkAbout25-4400 )STATE
TFcN 5 6 27i 1
Oc� RA EG09906
COLLISION REPRT 1591971
CASE# 25-4400 2
INTERSTATE CITY STREET❑ FIRE ❑
RESULTED
1 STOLEN r
STATE ROUTE ❑ OTHER ❑ VEHICLE � LOCAL A`GENO'Y 4100 3 L--�
HIT&RUN ❑ CODING
❑ COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 2 TRIBAL UN TS#OF OBJECK 1 1 8 28
03ISTRUC
OVER EMBANKMENT
RESERVATION ". + 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
cDLUSION' 05 - 19 - 2025 1432 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
BRONSON WAYNE MILE POST
e 275 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
0 6 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES Vl NO D:5099899292 30
6 LAST NAME BONAUDI FIRST NAME KAREN MIDDLE R 1 1 2 31
INITIAL
STREET 1:1 15205 140TH WAY SE APT D104 CITY RENTON ST WA ZIP 980587855 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYES NO YES NO
8 DRIVE # STATE WA SEx F MMoCSYY' 09 - 05 - 1946 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE' DP89851 STATE WA VIN# 5J6TF2H58DL005940 3
TRAILER STATE TRAILER ,STATE
11 0 0 PLATE# PLATE# FROM TO
rRLR TRLR 3 7 33
12 VIN# VIN
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 9 2013 HOND CROSST DAMAGE YES�No ✓� YEs_ 5 1 34
REGISTERED OWNER INFO KAREN BONAUDI 15205140TH WAY SEAPT D104 RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 3 4
14 FARMERS INSURANCE 18795546
IN EFFECT &POLICY# 4TOP
vEnic�E CHARGE 5 36
Lemur YES❑NO❑ CITATION# BOTTOM
15❑ sTnNowc Y e
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT ❑ ❑ PEDESTRIAN Q✓ D:2063315358
VEHICLE CYCLE' nWNFR YES f/ NO
16�
LAST NAME MOHAMADAMIN FIRST NAME SHALLAW MIDDLE I A
INITIAL
17 F1 STREET ❑' 1 371620 SE PETROVITSKY RD CITY RENTON ST, WA ZIP 980586637
NEW ADDRESS
1$ CDL IGNITION REQUIRED3 IGNITION PRESENT MEDICAL TRANSPORTED 38
INTEF�LOCKYEs No INTERLOC�CYEs No ves NO
19 DRIVER'S
# STATE WA SEXI M MMDDYY 01 O6 1987 39
20 ON DUTY STATUS 3 AIRBAG' RESTR EJECT HELMET 2 INJURY' 7 NATURE OF INJURIES ❑ 40
USE CLASS POSSIBLE KNEE INJURY
LICENSE ATE# TATE vIN# 41
21 P
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
GOV H 44
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY I
24 1 7 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
vemae ❑ ,.I—I CITATION# CHARGE tO BOTTOM
ALLr YES N`LJ
25 a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.CATALAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159(R 11/181
POLIICFETRAFFICN CORRECTION REPORT NO. EG09906
COLLISION REPORT III III III III III 111
1591972 CASE# 25-4400
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.CATALAN 05-20-25 02:35 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 711512025 1:49:21 PM
BADGE OR ID# 12007 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 2:32 Pry TIME POLICE ARRIVED 2:32 PM
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 57
REPORT NO.` EG09906 CASE# 25-4400 O COLLI COLLISION TIME
OF 05/19/25 14:32
COLLI
NARRATIVE
On May 19, 2025, at 1432 hours I flagged down by a passerby about a vehicle stuck in an
embankment at Kaiser Permanente, 275 Bronson Way NE, in the city of Renton, county of King, and
State of Washington.
While searching for the collision, I located the vehicle on the northeast side of the property. The
vehicle was as a Honda Crosstour bearing Washington plates DP89851. The driver, identified das
Karen Bonaudi, was sitting inside her vehicle. I asked if she sustained any injuries, and she said no.
Karen exited the vehicle and explained that she intended to park in a handicap stall belonging to
Kaiser Permanente. As she aligned her vehicle into the stall, her foot slipped and from the brake onto
the accelerator. Her vehicle rushed forward, ran over some shrubbery, and landed in between 2
handrails on a walkway.
Her vehicle sustained severe damage to the front bumper and damaged the two handrails.
While speaking with Karen, a security guard named Shallaw Mohamadamin, approached me and
said he sustained an injury to his knee. Shallaw said he was walking northbound along the walkway
when he heard a vehicle crashing through the bushes. He ran forward but was nicked by the vehicle
or the metal handrail. He sustained a minor abrasion to his knee and refused any medical assistance.
Based on the above statements, I determined that the Driver of Unit 1 (Karen) is the proximate cause
for the collision due to inattention causing a collision.
Due to the severe damage sustained by Karen's vehicle, it was towed away by Bankers Towing. An
exchange of information was provided to all involved parties
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
C. Catalan 06/02/2025 Renton
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EG09906POLICE TRAFFIC
1 27
... °`f COLLISION REPORT CASE# 25-4400
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
GWVR NO NUMBER
SOURCE AXLES + NAME IF
4a ❑ ADDITIONAL UNITS
MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
}j� PEDESTRIAN �/ D:4252352800
5 UNIT vT 3 VEHICLE CI CYCLE C) C� OWNER YES NO
29
FIRST NAME MIDDLE'
LAST NAME PERMANENTS KAISER INITIAL
STREET 30
NEW ADDRFR 275 BRONSON WAY NE CITY RENTON ST WA ZJP 98058
6 ❑ PRESENT MEDICALTANSPORTED. 1 31
CDL IONITION REQUIREfl IGNi71ON
INTERLOCK YES: NO {NTERLOCK YESL No I YES N .
DRIVER'S STATE SEX U MDJO -�-
LICENSE;
7
ON DUTY STATUS: AIRBAG RESTR. EJECT HELMET I INJURY NATUREOFINJURIES
USE CLASS
8 ❑ #LICENSE VIN 1 32
PLATE# rAr
9 TRAILER TRAILER 2
PLATE# STATE PLATE# STATE
10 ❑ TRLR TRLR
VIN.# VIN.R4
11 VEH.YEAR MAKE MODEL STYLE VEHICLE TO WE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO
DAMAGE YES NO YES NO
REGISTERED OWNER INFO. m 33
12 � SHADE IN DAMAGED AREA
LIABILITY INSURANCE❑ INSURANCE CO 4 FROM TO
TO
IN EFFECT &POLICY# 34
13 YES NO CITATION# CHARGE
10 8C)1`l OM
ecauv
DAMAGE THRESHOLD MET PHONE 35
sTnNoiNc
MOTOR PEDAL- ' PROPERTY 1:1
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
15 LAST NAME FIRST NAME ❑INITMIDDL
ALE 36
16 ❑ STREET CITY ST! ZIP
NEW ADDRESS"
GDL IGNITION REOUIRED IGNITION PRESENT MEl71CALTANSPORTED
INTERLOCK YES NO INTERLOCK YES NO YES NO
17 37
LLIRIVERSICENSE# STATE I SEX M�Dfl
18 ❑ ❑
HELMET INJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ ❑ 39
LICENSE viN#
PLATE# rAT
20 ❑ TRAILER TRAILER ❑ 40
PLATE#. STATE PLATE# STATE
21 ❑ TRLR TRLR 41
VIN#7 VIN#i
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
vEHic�F ❑ ❑ CITATION# CHARGE 24 IEG_ VES NOSTIWDING3 3 6
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 05-20-25 02:35 PM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 ORID# 12007 O#RI WA0171300 APJACOBS 7%15/2025 PAGE OFF
3000-345-013(R 11/18)
REPORT NO. EG09906 CASE# 25-4400 DATE AND TIME i 05/19/25 14:32
OF COLLISION
�a
oll
02
v
e
Y 4
$q*'Xq a awwxtl m !
y.
i
f
Z 4
� t
t
�y 1
�Y
�Yk
PAGE 5 OF 5