HomeMy WebLinkAbout25-6184 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG12393oc� RA
COLLISION REPORT 1591971
ASE# 25-6184 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AQENC'Y 4200 3
COUNTY RD ❑ NVOLVED CODING
PRIVATE WAY
2❑ 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
COLL.ISION'. 07 - 18 - 2025 1003 17 =.= S 8 W E OF IN M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
S 7TH ST BLOCK NO. e 100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 50 00 FEET e✓ S 8 W e RAINIER AVE S
2 0 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2532046802 0 1 30
6 LAST NAME DAL FIRST NAME KAM MIDDLE L 1 1 2 31
INITIAL
STREET ❑ 12307 SE 270TH ST CITY KENT ST WA ZIP 980307836 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES No✓
8 �CIENS # STATE WA SEX M MMDrYY' 12 — 10 — 1993 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM
USEET 2 1 INJURYCLASS 1 NAruRE of INJURIES 2
10 as ENSrtEI BZN8737 STATE WA VN# 5FNRL185X3B097069 3
11[-j— TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR TRLR 3 7 33
12 2 5 VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 4 2003 HOND ODYSSE DAMAGE YES DNO ✓ YEs_ No✓ 3 7 34
REGISTERED OWNER INFO FOKE HONE 12307 SE 270TH ST KENT WA 98030 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EF ITYINSURANCE� STATE FARM 446157tA1f47E
IN EFFECT &POLICY# i 4TOP 5
vEni CHARGE 7 o BOTTOM 36
15 STMLE"AL we yes❑NO❑ CITATION# 5A0563872 FLD SIGNAL STOPS/TURNS-UNSAFE B 7 e
MOTCYR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE' ❑ ❑ rtwNFR YE:
No �/ D:2532785979
16�
LAST NAME ELLIS FIRST NAME DOLAN MIDDLE' g
INITIAL
STREET ❑ 37
17 '❑ 8904 S 121ST ST CITY SEATTLE ST, WA ZIP 981784530
NEW AbORESS
1g❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPQRTED' 38
INTERLOCKYEs No✓ INTERLOCKYrS NO✓ YEs Nol✓
19 DRIVER'S STATE WA SEXI M D.0 B, 1 10 01 1991 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 LICENSEPLATE# CFD9123 rare WA vIN# 1 FMJK2A54AEB47748 41
22❑ PLATE# STATE PAAILER
TE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q1Q MAKE FORD MODEL EXPEDITI STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO DOLAN ELLIS 111.S 121ST ST SEATTLEWA 98178 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 988-480.470
IN EFFECT &POLICY# t
HICL Q
LEIAIL YES❑ NCLJCITATION# CHARGEtO VEE25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
D.NELSON 12421 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG12393
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6184
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME HARESCO ANNA M
(LAST,FIRST,MIDDLE INITIAL}
ADDRESS&PHONE#
6637 134TH PL SE NEWCASTLE WA 98059 2064349182 SEX' F MMooYYYv 08 - 08 - 1989
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
Ej 2 POS 3 2 4 1 USE 2 CLASS 11 NATU
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD -F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M -T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY rNATURE OF INJURIES
❑ Q' POS. GLASS — ----�
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.
D.NELSON 07-18-25 04:56 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 7/23/2025 3:47:33 PM
BADGE OR ID# 12421 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 10:05 AM TIME POLICE ARRIVED 10:15 AM
PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG12393 CASE# 25-6184 O COLLI COLLISION TIME
OF 07/18/25 10:03
COLLI
NARRATIVE
25-6184 ACC
On 7/18/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a two-vehicle non-injury collision near the intersection
of S 7th St and Rainier Ave S Renton/King/WA. An involved party was calling to report that there
were no injuries, and they were blocking a lane of travel.
I arrived on scene and located both vehicles in lane 1 of westbound S 7th St just east of Rainier Ave
S. I confirmed that there were no injuries, and both vehicles were able to move out of the roadway.
The driver of the green 2003 Honda Odyssey WA/BZN8737, was identified by his WADL as Kam L
Dal DOB: 12/10/1993. Kam said that he was driving west in the number 2 lane when someone behind
him honked. He said that this scared him, and he veered to the right colliding with the Expedition.
There was minor passenger side front quarter panel damage and no airbag deployment. The
Odyssey was drivable.
The driver of the gray 2010 Ford Expedition WA/CFD9123, was identified by his WADL as Dolan B
Ellis DOB: 10/1/1991. He advised that he was driving west in the number 1 lane when the Odyssey
veered into his causing minor driver side front bumper damage and a flat tire. Dolan did not request a
tow and said he would change the tire himself.
I provided both parties with an exchange of information and left the scene.
Based on Kam's unsafe lane change I cited him for RCW 46.61.305 Unsafe Lane Change under
Sector citation #5A0563872. This citation should be mailed to Kam.
46.61.305 states the following:
(1) No person shall turn a vehicle or move right or left upon a roadway unless and until such
movement can be made with reasonable safety nor without giving an appropriate signal in the
manner hereinafter provided.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 7/18/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG12393 CASE# 25-6184 DATE AND TIME i 07/18/25 10:03
OF COLLISION
t
t
9
tt�.
i
s
t
t{
i t
S
tl'r
1
`"u st€ ion
o b z
^ t
yy
PAGE 4 OF 4