HomeMy WebLinkAbout25-6009 )STATE
TFC 2 0 27I
OICERAF EG11783
COLLISION REPRT 1591971
CASE# 25-6009 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL ACENC'Y 4100 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL UNITS#OF 02 28
TRUCK 0 6
RESERVATION 1 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coLLISION' 07 - 12 - 2025 0738 17 =.= S 8 W E IN OF M ?070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION BLO❑
MAPLE VALLEY HIGHWAY MILE POST
e 1820 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �.� FEET e S 8 W e UNKNOWN
0 5 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE ❑ CYCLE ❑ YES No �/ D:2538889037 0 2 30
5 LAST NAME CHOHRACH FIRST NAME CAYDEN MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 280 IRON MOUNTAIN RD CITY CLE ELUM ST WA ZIP 989228490 2
NEW ADDRESS
7 CDL IGNITION REOUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES D NO✓ I INTERLOCKYES Na✓ YES R NoF,/
8� LICIENS# STATE WA SEx M MMOCSYY' 10 1 2 32
9 URY NATURE OF IN
ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT,. ? HELMET U S ASS ,.6 NECK PAIN JURIES 2
10 LI ENS ATFUE' 12210AD STATE WA VN# 1BNIP153XWK011411 3
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# ROM TO
TRLR TRLR $ $ 33
1 3 5 VIN# vI.
( FROM TO
2
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 2 199$ KW CONST TL DAMAGE YES NO ✓ YEs❑ No✓ $ 4 34
REGISTERED OWNER INFO NEWELL BROTHERS INC 1260334TH A VE E TACOMA WA 98446 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 ✓ WESTERN NATIONAL MUTUAL CPP 118569
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t 5 36
Lemur YES❑NO❑ CITATION# 7 o BOTTOM
15❑ nNowc e
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
VEHICLE
UNIT 02 CYCLE (7WNPR Q ❑ PEDESTRIAN ❑ D:5037295381
YES NO ✓
16�
LAST NAME WELLS FIRST NAME DAMITRE MIDDLE I A
INITIAL
2 STREET ❑
17 ❑ ?330 NE ALBERTA ST CITY PORTLAND ST I OR ZIP 97211 4 37
NEW AbbRESS
1$❑ CDL IGNITION REGlUIRED IGNITION PRESENT MEDICAL TRANSPORTED; 38
INTERLOCKYES No✓ INTERLOCK YES NO✓ vEs No✓
19 DRIVER'S STATE OR SEk M D.O.B. 12 29 1999 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG'2 RESTR 4 EJECT 1 HELMET INJURY' 6 NATURE OF INJURIES 40
USE CLASS BACK PAIN
21 LICENSLATE E NO LICENSE PLATE rare OR VIN# 1N4BL3AP4DN458569 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2013 MAKE pJJSS MODEL ALTJMA STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO DAMITRE11ELLS1330NEALBERTAST PORTLANDOR97211 D:5037295381 VEHICLE NO.2
SHADE IN DAGAREA
2
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 979532789
IN EFFECT &POLICY# t 9TOP 5
VeeiCLe ❑ ,J—I CITATION# CHARGE tO BOTTOM
LecnLLr YES N`[_
25 a 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG11783
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6009
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.
STEVEN FAJARILLO 07-12-25 08:55 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 7/22/2025 4:04:23 AM
BADGE OR ID# 9Y847 ORI#' f WA0171300 TIME POLICE DISPATCHED'; 7:41 AM TIME POLICE ARRIVED 7:46 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT No.` EG11783 CASE# 25-6009 O COLLI COLLISION TIME
OF 07/12/25 07:38
COLLI
NARRATIVE
25-6009
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 07-12-2025 1 was working as a police officer in the city of Renton. At approximately 0741 hours I
was dispatched to the report of a collision outside of Mizu's Japanese Steakhouse, 1820 Maple
Valley Highway, City of Renton, County of King, WA. This incident was captured on my department
issued Axon body camera.
According to the notes in the call, there was a 2 motor vehicle collision at the intersection.
I arrived on scene and contacted the driver of Vehicle 1. He advised he was traveling southeast and
needed to make a U-turn. He was in the turn lane. When the light turned green he turned on his
flashers and moved right in order to make a U-turn due to the size of his vehicle. As he started
moving to the left Vehicle 1's front driver side bumper and wheel collided with Vehicle 2's passenger
rear door. The driver of Vehicle 1 did not see Vehicle 2.
The driver of Vehicle 2 was also travelling southeast. He believed the truck was going straight
through the intersection because it went into the through lane. He tried to overtake the truck from the
turn lane.
Both drivers were evaluated and cleared medically by the fire department for some minor pain.
I photographed both vehicle's damage and uploaded the pictures to Evidence.com. Both vehicles
were drivable. I provided both drivers with case numbers.
According to the facts regarding this case, the U-turn and passing in the turn lane were the proximate
cause for the collision.
There is no further information available at this time.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Fajarillo #12847 on 07/12/2025 @ 0854 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EG11783 CASE# 25-6009 DATE AND TIME i 07/12/25 07:38
OF COLLISION
i�
a
a
Lra
� tia � k1xa5' r
3
1
a�
a e
ti
� O i
z
PAGE 4 OF 4