HomeMy WebLinkAbout25-6417 TFFiNouCERA II I III 1 III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-6417 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HIT& F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3 DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cowsloN 07 - 1-- 2025 0704 17 ❑.= S IN 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE S BLOCK NO. e✓ 18002
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES❑ �.❑ FEET e S ❑ W e SE 180TH ST
OF,1 29
MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE
UNITS VEHICLE ❑ CYCLE ❑ YEs �/No D:4258734631 0 8 30
6❑ LAST NAME EMERY FIRSTNAME HAYLEY MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 2221 VASHON AVE NE CITY RENTON ST WA 2jp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 11 — 11 — 1992 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10[1P1 ATNFS14 CPD6508 STATE WA u N# KNDJD733955427534
11[-3 TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR. 1 5 33
12 0 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T k GOVT.VEHICLE g 9 34
13 4 2005 KIA SORENT UT DAMAGE YES NOBS YES❑ No✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO MUTUAL OFENUMCLAW 8A5007869 3 4
IN EFFECT &POLICY# 9TOP
LEGALLE CHARGE 1 5 36
LECALLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLDMET PHONE
�Ul
NIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNFR ❑ YES 1/ NO D:4148038115
16 a
LAST NAME MCMURTRY FIRST NAME SHAUN MIDDLE E
INITIAL
17❑ NEW STREETREs7 10421 SE 202ND PL CITY' KENT ST WA ZIP 98031 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK YEs❑NOF YES
❑NOF,/
19 DRIVER'S STATE WA SEX M I D.C.B. 05 _ 30 _ 1975 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS BACK PAIN
❑LICENSE I 21❑ PLA E# CSX7339 TATE 41
WA VIN# 7SAYGDEF9PF968423 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2023 MAKE TESL MODEL Y STYLE $D —FEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGE$AREA
2 3 �d
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04468-39-56-88IN 1 9TOP 5
VEHICLE CITATION# CHARGE i o BOTTOM
LEGALLY YES[Z N�
25❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
SLAKE BOWIE 12105 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
WASHINGTO
POLICE TRAFFIC N CORRECTION REPORT No. EG 14268
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6417
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) SOMSAN/T-MCMURTRY JEAN
(LAST FIRST,
ADDRESS&PHONE# D O.B.
10421 SE 202ND PL KENT WA 98031 SEX F MMDDYyry 09 - O6 - 1982
PASSENGER Z WITNESS❑'UNIT# 2 SOS 3 AIRBAG 2 RESTR. q EJECT ? HELMET INJURY NATURE OF INJURIES
USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# Ly O B
SEX MMDDYVYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On 07-26-2025 at 0704 hours I was parked near the intersection of 108th Ave S / S 180th St, in the
City of Renton, County of King, State of Washington, when I heard a large smash sound
accompanied with screeching tires.
I went to the intersection and found Unit 1 stopped in the middle of 108th Ave S just south of the
intersection facing southbound. The front left tire/wheel was smashed and the vehicle was unable to
drive. I contacted the driver of Unit 1 and she stated she was okay. She informed me that she was
driving south on 108th Ave S when she was distracted by something she was doing in her car and
drifted over into the other lane. By the time she recognized she was in the other lane it was to late to
correct it so she hit the back corner of Unit 2.
Unit 2 was stopped at the red light facing southbound on 108th Ave S when they were hit in the back
from Unit 1. The driver of Unit 2 complained of back pain but no major injuries at this time.
I provided each driver an exchange of information and both vehicles were towed from the scene.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electrically signed by Officer B. Bowie / 12105 on 07-26-2025 at 0758 hours in the City of Renton.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
SLAKE BOWIE 07-26-25 07:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 713012025 3:48:41 AM
BADGE OR ID# 12105 ORI# WA0171300 TIME POLICE DISPATCHED 7:04 AM TIME POLICE ARRIVED f 7:04 AM
PART B PAGE IT]OF 3�
REPORT NO. EG 14268 CASE# 25-6417 DATE AND TIME 07/26/25 07:04
OF COLLISION
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