HomeMy WebLinkAbout25-5221 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG10561oc� RA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-5221 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LdCAI-A`NG 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY ❑ INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3I M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s o v' 06 - 15 - 2025 1647 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO.
3801 NE 4TH ST
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 5001.1 00 FEET e✓ S 8 W e UNION AVE NE
1 9 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:9253030726 0 1 30
5❑ LAST NAME BAHAM FIRST NAME SETH MIDDLE A 1 2 31
INITIAL
STREET ❑ 22207 SUMMERS RD SW CITY; CENTRALIA ST WA ZIP; 985319434 2
NEW ADDRESS
7 CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO✓ INTERLOCKYEs NO✓ YEs NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 10 — 25 — 1995 1 2 32
-NJUR
9 ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY',1 [NATURE of INJURIES 2
10 LI ENSE' BVT3864 STATE WA VIN# 1J4GA59148L623999 3
TRAILER STATE TRAILER STATE ROM To 11 0 0 PLATE# PLATE#
TRLR zRLR 5 1 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2008 MAKE JEEP MODEL WRANG STYLE V Y EHICLE TOWED TO BLIN TOWED By GOVT V 7 $EHICLE 34
13� DAMAGE YES II_II NO ✓ YESII_I) NO✓
REGISTERED OWNER INFO SETH BAHAM3315314TH PL FEDERAL WAY WA 98003 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 3 4
4 LIABILITY INSURANCE INSURANCE CO
14 Z USAA G1C 040870398 7104
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t S 36
LecnLLr yes❑NO❑ CITATION# 7 0 80TTOM
15❑ sTnNowc 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ cvcLE ❑ ❑ PROPSnWNr vEs✓ No D:2532486134
16�
LAST NAME MCCOY FIRST NAME SHANNON MIDDLE M
INITIAL
STREET ❑ 37
17 ❑ 2913 NE 7TH ST CITY RENTON ST, WA ZIP 980563755 4
NEW ADDRESS
18❑ CDL IGNITION REQUJRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs ND✓ jNTERLOCK YES NO✓ YEs NO I✓
19 DRIVERS '
MMDDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS NECK
21 LICENSE BHM2096 rare WA vIN# WMWRC33516TK16354 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2006 MAKE MI11N1 MODEL COOPER STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24� DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO KERRYMCCOY2913 NE 7TH ST RENTON WA 98056 VEHICLE NO.2
SHADFjy DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCECO STATEFARM4233846-Di6.47B
IN EFFECT &POLICY# 9TOP
VEHICLE ❑ ,J—I CITATION# CHARGE t080TTOM
EEEILY YES N J
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.CHANG 10065 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG10561
COLLISION REPORT III III III III III 111
1591972 CASE# 25-5221
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) SUNRISE INDIGO
ADDRESS&PHONE# D�
331 S 314TH PL FEDERAL WAY WA 980035213 4253893022 SEXi M MMDDYYYY 05 — 22 — 2000
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z � 1 POS. 3 2 4 1 USE 1 2 CLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS R PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE OF INJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
RTF
On 06-15-2025 at about 1657 hours, I was sent to an collision which occurred at 3801 NE 4th St, with
in the City of Renton, King County, Washington.
Upon arrival both drivers had the same account of what happened.
Unit 1 was coming out of a driveway and moved into lane 1 eastbound. Unit 2 was traveling
eastbound in lane 1 when she struck unit 1.
Unit 1 received scratches to a heavy duty extended bumper. Unit 2 received a lot of front end
damage and needed to be towed away.
Unit 1 did not yield right of way when exiting the driveway.
The driver of unit 2 had a sore neck.
Both drivers were identified via their WADL.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 06-24-25 06:31 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 711712025 1:41:19 PM
BADGE OR ID# 10065 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:57 PM TIME POLICE ARRIVED i 5:06 PM
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG 10561 CASE# 25-5221 DATE AND TIME 06/15/25 16:47
OF COLLISION
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