HomeMy WebLinkAbout25-6453 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG15668oc� RA
COLLISION REPORT 1591971
CASE#I 25-6453 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`GENC'Y 4100 3[--�
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL 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
OOLLISION' 07 - 29 - 2025 2136 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
S GRADY WAY
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ . FEET e S 8 W e RAINIER AVE S
OF 6 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs V No D:2065514925 0 8 30
5 LAST NAME DAHL FIRST NAME DEANNA MIDDLE M 1 2 31
INITIAL
STREET ❑ 22612 6TH AVE S APT 2 CITY DES MOINES ST WA ZIP 981986865 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCKYES NO✓ INTERLOCKYES Na✓ YES NO✓
8 DRIVER'S
STATE WA SEx F MMorYY' 11 - 13 - 1987 t 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 1 INJURY CLASS 1 NATURE OF INJURIES 2
LICENSE, CBL8387 STATE WA VN# 5TDBK3EH7DS217602 3
10 Fl I PI ATP rt
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# ROM TO
rRLR TRLR 3 5 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 3 9 34
13 8 2013 TOYT HIGHLA SV DAMAGE YES DNO ✓ YES❑ NO✓
REGISTERED OWNER INFO REBECCA BROWN 1005420TH AVE SW SEATTLE WA 98146 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 2 3 4
14 ✓ STATE FARM 4412256-DOS-478
IN EFFECT &POLICY# 4TOP 11
VEHICLE CHARGE 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:7022198934
YES✓ NO
16�
LAST NAME RASSA FIRST NAME PEYMAN MIDDLE' A
INITIAL
STREET ❑ 37
17 '❑ 4116 CALIFORNIA AVE SW APT 20 CITY SEATTLE ST, Wq ZIP 981164170 4
NEW ADDRESS
18❑ CDL ...; IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYEs NO✓ INTERLOCK YES No✓ YES NO;✓
19 DRIVER'S STATE WA SEA M D.O.6. 08 16 1969 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 7 2 INJURY NATURE OF INJURIES 40
USE CLASS NECK
21 LICENSE CMR6522 rarE WA vIN# KNDCR3LE9R5176833 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2024 MAKE KIq MODEL NIRO STYLE $�/ VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO ANTON POUAKOV 11.1198114AVE NE WOODINV/LLE WA 911077 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE✓ INSURANCE CO TRAVELERS 1R571635-TXS-25
IN EFFECT &POLICY# t 9TOP
veeicLe ,J—I CITATION# CHARGE tO BOTTOM
Lecnttr YES N`[
25 a 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
ROBIN SMITH 12986 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG15668
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6453
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.
ROBIN SMITH 08-02-25 03:39 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 81312025 8:06:48 PM
BADGE OR ID# 12986 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 9:44 pry/ TIME POLICE ARRIVED 9:46 Pm
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47
REPORT NO.` EG15668 CASE# 25-6453 O COLLI COLLISION TIME
OF 07/29/25 21:36
COLLI
NARRATIVE
25-6591
Unless otherwise stated, the following occurred in the City of Renton, County of King, State of
Washington.
On 07-29-2025 at approximately 2136 hours I was dispatched to a two-vehicle collision blocking
traffic at Rainier AVE S and S Grady WAY. Dispatch advised there were no injuries.
Upon arrival, I contacted the involved parties and determined that the driver of Unit#1 was
complaining of neck pain. The Renton Regional Fire Authority (RRFA) later arrived on scene and
treated the involved driver. RRFA released all involved parties at the scene. While on scene, I
collected the involved parties driving documents and their independent recollection of events leading
up to the collision.
The driver of Unit#2 said he was the sole occupant of his vehicle and was stopped at a red light
facing westbound waiting to turn southbound onto Rainier AVE S from S Grady Way. The driver of
Unit#2 stated he was rearended by Unit#1. There was damage to the rear of Unit#1 along the
bumper.
The driver of Unit#1 said she was the sole occupant of her vehicle, and she was traveling westbound
on S Grady Way approaching Rainier AVE S. She was in the turn lane to head southbound on
Rainier AVE S and said the light was green and Unit#2 didn't proceed forward. Since Unit#2 didn't
move forward, the driver of Unit#1 failed to stop and rear-ended Unit#2. There was minimal front-
end damage to Unit#1, but there was fluid leaking from the front end.
Based on the above statements, 1 determined that the Driver of Unit #1 is the proximate cause for the
collision due to inattention causing a collision.
An exchange of information was provided to all involved parties.
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 Robin Smith #12986 on 08/02/2025 @ 0325 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EG 15668 CASE# 25-6453 DATE AND TIME i 07/29/25 21:36
OF COLLISION
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