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HomeMy WebLinkAbout25-6620 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG15795oc� RA COLLISION REPORT 1591971 CASE# 25-6620 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4100 3 COUNTY RD NVOLVED CODING PRIVATE WAY 2❑ TRIBAL TOTAL 1 UNITS#OF 03 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 COLLISION'. 07 - 31 - 2025 1445 17 =.= S 8 W E IN OF M 1070 a 4�] ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ BLOCK NO. RAINIER AVE N 4a 9❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ . FEET e S 8 W e RENTON AVE S 2 0 29 MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:2068804640 Q 7 30 5 LAST NAME LOZANO MENDOZA FIRST NAME WIMPER MIDDLE 1 O 1 1 2 31 INITIAL STREET ❑ 254 UNION AVE NE CITY RENTON ST I WA ZIP 98059 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES No INTERLOCKYEs NQ YES F NO 8 LICIENS# STATE WA SEX M MMOCSYY' 03 1 2 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY CLASS 1 NAruRE of INJURIES 2 LICENSE, CPJ4796 STATE WA VN# KMHCM36C59U109799 3 10 PI ATP tt TRAILER STATE TRAILER ,STATE 11 3 5 PLATE# PLATE# FROM TO rRLR TRLR 7 3 33 1 0 ( FROM TO 2 Q VIN# VIN# VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 9 9 34 13 4 2009 HYUN ACCENT DAMAGE YES DNO YES❑ NO REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ ❑ NSURANCE CO 3 4 LIABILITY INSURANCE IN EFFECT &POLICY# i 4TOP 5 vEnic�E CHARGE 10 BOTTOM 36 srnNoiNc YES[:]NO[:] CITATION# 5A0625700,5AO625700, OP MOT VEH W/OUT INSURANCE,NO 15 7 e III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES�/ NO D:6018965370 16� LAST NAME MODOMO FIRST NAME MA MIDDLE' M INITIAL 17 F1 STREET ❑'❑ 17136 164TH WAY SE CITY RENTON ST, yyq ZIP 37 980589582 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38 INTERLOCKYES No INTERLOCKYES 0NO YES NO' 19 DRIVER'S STATE WA SEXI F D,013, 06 29 2000 39 LICENSE# MMDDYY - 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE A INJURIES ❑ 40 USE CLASS NECK PAIN 21 LICEN� BWV2032 rarE WA vIN# JTMZD32VO75050271 41 PLATE 22❑ STATE TILER PATE# STATE ❑ 42 PLATE# 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2007 MAKE TOYT MODEL RAV4 STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO KAREN MODOMO 17136164TH WAY SE RENTON WA 98058 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO STATE FARM 485 3541-A29.47A IN EFFECT &POLICY# t 9TOP v 1— LecnLLY ,.I—I CITATION CHARGE tO BOTTOM `.LJ 25 YES N a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 C.ARNOLD 12509 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EG15795 COLLISION REPORT III III III III III 111 1591972 CASE# 25-8820 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL} ROTHWELL ANDREW G (LAST,FIRST ADDRESS&PHONE# D(� 5119 S ANGELINE ST SEATTLE WA 98118 SEX' M MMoovvvv 09 - 01 - 1984 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES �; 3 POS. ' 3 2 4 1 USE 'CLASS ;1 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# ' D.O.B. SEX MMDD -F L----------� YYYY PASSENGER F]WITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF 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 NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----� 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. C.ARNOLD 07-31-25 04:43 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE RAYMOND GORAJEWSKI 12399 8/4/2025 8:21:34 AM BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 2:47 Pry) TIME POLICE ARRIVED 2:54 PM PART B 3 Do-3mx-,ao(Burls) PAGE 27 OF 57 REPORT NO.` EG15795 CASE# 25-6620 O COLLI COLLISION TIME OF 07/31/25 14:45 COLLI NARRATIVE CC 25-6620 On 7/31/2025 at 1447 hours I was dispatched to a motor vehicle collision at the intersection of Rainier Ave N and Renton Ave in the City of Renton, King County, Washington. Pre-Collision Driver 3 stated that she was in the 2-way center turn lane facing East on Renton Ave approaching Rainier Ave N. Driver 2 stated that she was stopped in the #2 lane for traffic on Renton Ave facing East. Driver 1 stated that he had just left McDonalds and was attempting to merge from the #1 lane all the way to the 2-way center turn lane. Collision Driver 3 stated that as she was continuing forward, Unit 1 emerged from the #2 lane and the front drivers side bumper of Unit 1 collided with the front passenger side of Unit 3. Driver 2 stated that while stopped, Unit 1 pulled into the 2-way center turn lane and there was a collision. Driver 2 stated that this collision forced Unit 1 into the rear drivers side bumper and quarter panel of her vehicle. Driver 1 stated that he did not see Unit 3 until it was too late. Driver 1 stated that as he entered the 2- way center turn lane the front passenger side bumper of Unit 3 collided with the front drivers side bumper of Unit 1, which forced Unit 1 partially back into the #2 lane of travel where the front passenger side bumper of Unit 1 collided with the rear drivers side of Unit 2. Driver 1 stated that he did not have insurance and per a check of DOL his driving status showed as Not Licensed -Eligible. Injuries Driver 3 and 2 reported neck pain. Driver 3 also reported back pain. Vehicle Disposition All vehicle were operational. Proximate Cause I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as nearly as practicable entirely within a single lane and shall not be moved from such lane until the driver has first ascertained that such movement can be made with safety. Driver 1 was cited per RCW 46.61.140, RCW 46.30.020, and RCW 46.20.015. 1 certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer C. Arnold #12509 at 16:25 on 7/31/2025 in the City of Renton, King County, Washington. PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EG1 5795 POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE#+ 25-6620 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACAR©. GWVR NO NUMBER SOURCE AXLES1:1 + NAME IF 4a ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE }} PEDESTRIAN �/ D:2534411118 5 UNIT vT 3 VEHICLE CYCLE C) C� OWNER �'. YES NO 0 1 29 LAST NAME ROTHWELL FIRST NAME GAIL MIDDLE W INITIAL STREET 30 NEW ADDRF�, 5119 S ANGELINE ST CITY SEATTLE ST I WA ZJP 981181530 6 [2 PRESENT MEDICALTANSPORTED' 1 1 2 31 CDL IGMTION [.RECJUIRED 'iGNi710N INTERLOCK YES NO 'INTERLOCK YEs rya G DRIVERS STATE D.O,B LICENSE p►/q SEX F MMDDYYY 01 - 14 - 1949 HELMET ,INJURY NAruRE OF INJURIES ON DUTY STATUS: AIRBAG 2 RES7R. ¢ EJECT 1 USE GLASS 7 NECKAND BACK PAIN LICENSE I CHR6654 rar WA VIN# 4T3D6RFV5PU129607 PLATE# 9 Fil STATE TRAILER TRAILER 2 PLATE#i PLATE# STATE 10 ❑ TRLR TRLR VIN.# VIN.#. 11 3 5 VEH.YEAR2023 MAKE TOYT MODELRAV4 STYLE VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO DAMAGE YES NO 1,/l YES NO REGISTERED OWNER INFOOWNED BYDRIVER 7 3 33 12 � SHADE IN DAMAGED AREA 4 FROM TO INSURANCE CO LIABILITY INSURANCE OE1C0 4406504490 IN EFFECT &POLICY# 1 TZt1F- _ 5 m 34 13 vewcEe YES NO CITATION# CHARGE 10 NOTTC)M ecauv sTANOINc 3 7 ti MOTOR PEDAL_ ' PROPERTY DAMAGE THRESHOLD MET PHONE ❑ 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 36 15 LAST NAME FIRST NAME NIIT ALE MIDDL ❑ 16 ❑ STREET CITY ST ZIP NEW ADDRESS" GDL IGNITIC7N RE(]UIRED IGNI71©N PRESENT MEDICAL TANSPORTED INTERLOCK YES NO INTERLOCK VES NO .YES NOD 1 17 37 DRIVERS # STATE SEX M�DDWY - 18 ❑ ❑ HELMET NJURY NATURE OF INJURIES 38 ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS 19 ❑ ❑ 39 LICENSE vIN PLATE# TAT # 20 ❑ TRAILER TRAILER ❑ 40 PLATE#. STATE PLATE# STATE 21 ❑ TRLR TRLR 41 V1N# UIN#'. 42 22 VEH.YEAR MAKE I MODEL I STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAMAGED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT I &POLICY# tK-99 5 44 vewcEe ❑ ❑ CITATION# CHARGE 24 IEGALLY VES NO3 3 6 I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.ARNOLD 07-31-25 04:43 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED %4%2RD ORI AP 26 BADGE 12509 # WA0171300 APPROVED PAGE OFF5 3000-345-013(R 11l18) REPORT NO. EG 15795 CASE# 25-6620 DATE AND TIME i 07/31/25 14:45 OF COLLISION tl �o Sr t i 1 t s \ 3 H } 4 ti5u I i PAGE 5 OF 5