HomeMy WebLinkAbout25-6026 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG09907oc� RA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE ❑
CASE�# 25-6026 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCCO A`NG 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' 07 - 12 - 2025 1821 17 =.�� S W e IN
OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
RAINIER AVE S BLOCK NO. e 400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 40 00 FEET e✓ S 8✓ W e S 4TH PL
2 0 29
F
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES ✓NO D:2066719512 0 1 30
5 LAST NAME CEDENO PONCE FIRST NAME VALERIA MIDDLE A 1 1 2 31
INITIAL
STREET E1 4316 S 181ST ST
NEW ADDRESS CITY SEATAC ST I WA ZIP 981884548 2
7 CDL IGNITION REQUIRE6 IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYES �/NO INTERLOCKYES NO YES D NOF,/
8 DRIVER' # STATE WA SEX 16 F M MDr YY' O6 — — 2006 1 2 32
9� ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CTA5194 STATE WA VN# JTDKB20U577585810 3
10 PI ATF#
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TRLR 5 1 33
1 3
FROM TO
2 5 VIN# vI.
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 3 2007 TOYT PRIUS DAMAGE YES�NO� YES 34
REGISTERED OWNER INFO JOSE CEDENO MARTINEZ 4316 S 181ST ST SEATAC WA 98188 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 3 4
14 3 LIABILITY INSURANCE❑ NSURANCE CO
IN EFFECT &POLICY# iQ�Q
5
v `LE CHARGE 36
STML LNG YES❑NO❑ CITATION# 5A0297077,5AO297077 NO VALID OPER LICENSE WITH
15
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
VEHICLE
UNIT 02 Q CYCLE ❑ PEDESTRIAN ❑ OWNER D:5303015397
YES NO
16�
LAST NAME TREAD WAY FIRST NAME PA NHIA MIDDLEI Y
INITIAL
❑
17 F1 STREET' 5722 BAYWOOD WAY CITY MARYSV/LLE ST CA ZIP 95901 37
NEW AbbRESSO
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED ❑ 38
INTERLOCKYES NO INTERLOCK YES NO YES No
19[ DRIVER'S STATE CA SEY F D.O-B. 1 05 26 1984 ❑ 39
LICENSE# MMDDYY —
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 LICENSLATE E 34217E3 rare CA VIN 3GTU9CED2MG249194 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2021 MAKE GIVjC MODEL SIERRA STYLE VEHICLE TOWED N.0 BLIN
TOWED BY GOV HI 44
24 DAMAGE YES YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO AAA CAAS201478456
IN EFFECT &POLICY# 9TOP
vew LE ❑ ,.I—I CITATION11 CHARGE t08OTTOM
A Y YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG09907
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6026
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
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
*Video of incident available from Unit 2's relative, unsubmitted as of this report.
Unit 2 was in the far left, left turn lane on northbound Rainier AVE S, stopped in traffic back from the
light at S 4th PL, intending to turn left (westbound) into a private parking lot. Unit 1 was in the lane to
the right (east) which is a straight forward only lane. Unit 1 intended to change lanes left (west) into
the left turn lane occupied by Unit 2. As traffic was not moving, Unit 1 began to change lanes moving
approximately 2-3 feet into the lane before they had to stop due to traffic not moving. Unit 2 was
approximately 1 car length back from Unit 1 and Driver 2 states she did not see Unit 1 move into the
lane. When the light turned green, Unit 2 began to travel forward as Unit 1 continued into the lane
and into the path of Unit 2. The front driver's wheel area of Unit 1 was impacted by the front of Unit 2.
Both unit's sustained moderate but non disabling damage.
Driver 1 was ID'd via WA ST ID card and she stated she only had a Venezuela driver's license.
Driver 1 advised she did not have insurance for the vehicle.
Driver 1 and Unit 1 were the proximate cause of the collision by making an unsafe lane change into
the lane occupied by Unit 2 resulting in a collision. Driver 1 was not cited for this offense as Driver 2
had time and opportunity to avoid the collision, but instead drove forward stating Unit 1 was in her
blind spot.
Driver 1 was cited for operating a motor vehicle without a valid operators license (NVOL) with a valid
WA ID card. Driver 1 was also cited for operating a motor vehicle without insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 07-14-25 10:34 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 711512025 1:47:28 PM
BADGE OR ID# 10008 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:26 PM TIME POLICE ARRIVED 6:30 PM
PART IS 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG09907 CASE# 25-6026 DATE AND TIME 07/12/25 18:21
OF COLLISION
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