HomeMy WebLinkAbout25-6565 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG15799oc� RA
COLLISION REPORT 1591971
ASE# ; 25-6565 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 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
coLLISION' 07 - 30 - 2025 1126 17 =.�� S WE IN
OF 1070 3
4� ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
RAINIER AVE S BLOCK NO. e 100 .�
4a� MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 100 00 FEET e✓ S 8✓ E e Y
-] MILES N AIRPORYWA
2 0 29
F
MOTtlR ✓ PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE CYCLE' YES NO ✓ D:2Q629Q9692 Q 1 30
5 LAST NAME LEWIS FIRST NAME JALIYAH MIDDLE M 1 1 2 31
INITIAL
STREET 2223 BENSON RD S CITY RENTON ST WA ZIP 980558834 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ INTERLOCKYEs NO✓ YES D NOW
8❑ LICIENS# STATE WA SEX F MDmopyy' 01 — 02 — 2006 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CPW0675 STATE WA VN# 1HGCV1F37JA179060 3
10 PI ATF#
TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR TRL.R 5 1 33
1 2
FROM TO
2 5 VIN# VIN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 201$ HOND ACCOR DAMAGE YES�No ✓� ves_ No✓ 5 1 34
REGISTERED OWNER INFO UALIYAH LEWIS 2223 BENSON RD S APT FF202 RENTON WA 98055 D:2062909692 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
4 NSURANCE CO 3 4
14 LIABILITY INSURANCE� PROGRESSIVE 997263922
IN EFFECT &POLICY# i 4TOP 5
VEHICLE CHARGE 7 0 80TTOM 36
15
srnrroiNc YES❑NO❑ CITATION# 5A0563882 FLD SIGNAL STOPS/TURNS-UNSAFE s 7
III MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES NO �/ D:2064077748
16�
LAST NAME KASSA FIRST NAME ABREHAM MIDDLE T
INITIAL
17 STREET'O 21003 3 ❑7TH CT S CITY SEATAC ST, WA ZIP 37
981986702
NEW AbORESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. ❑ 38
INTERLOCKYEs No✓ jNTERLOCKYEs No✓ vEs No;✓
19[ DRIVER'S STATE WA SEXI M I D.O.B. 08 12 1949 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 4p
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21[—] LICEN� AZX8860 TATE WA vIN# JTDZN3EU2D3210576 41
PLATE 22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q13 MAKE TOyT MODEL PRIUS V STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO ABREHAM.SSA2100337THCTS SEATACWA98198 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO STATE FARM 579 9295 D20 47
IN EFFECT &POLICY# 9TOP
veeiae ❑ ,J—I CITATION# CHARGE 1060TTOM
LecnLLY YES N`[
25 e
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. EG15799
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6565
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL} RADCLIFF PATRICK O
(LAST,FIRST
ADDRESS&PHONE# DOB
11315 26TH AVE S APT 5-306 BURIEN WA 981681860 2062909692 SEX' M MMDDYYYY 10 - 26 - 1994
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER�WITNESS� UNIT 1 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 17 COMPLAINT OF HEAD AND RIGHT
ANKLE PAIN
'NAME
(LAST ,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M -F L----------�
MDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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 PEA USE 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 08-01-25 01:39 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
RAYMOND GORAJEWSKI 12399 8/4/2025 8:18:11 AM
BADGE OR ID# 12421 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 11:28 AM TIME POLICE ARRIVED 11:34 AM
PART B 3 Do-3mx-,ao(RI1Y1s) PAGE 27 OF 47
REPORT NO.` EG15799 CASE# 25-6565 O COLLI COLLISION TIME
OF 07/30/25 11:26
COLLI
NARRATIVE
25-6565 ACCINJ
On 7/30/2025 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 collision with injury in the 100 block of Rainier Ave S
Renton/King/WA RRFA was started and both vehicles had pulled into a nearby restaurant.
I arrived on scene and located RRFA evaluating one patient. Officer Catalan was gathering
information from both parties.
The driver of Unit 1, a 2018 Honda Accord WA/CPW0675, was identified by her WADL as Jaliyah M
Lewis DOB: 1/2/2006. She said that she was in the #2 northbound lane of Rainier Ave S and was
trying to get into the left-hand turn lane to turn west on Rainier Ave Ext Rd. Jaliyah said that she
began to change lanes and that was when she collided with Unit 2. There was damage to the rear
driver side bumper/quarter panel of Unit 1. No airbags had been deployed.
Jaliyah was not injured; her passenger was identified by his WADL as Patrick O Radcliff DOB:
10/26/1994. Patrick had a previously broken right ankle and said he had a complaint of pain to his
right ankle and head. He was evaluated by RRFA on scene and transported to VMC for further
treatment.
The driver of the 2013 Toyota Prius WA/AZX8860, was identified by his WADL as Abreham T Kassa
DOB: 8/12/1949. He said that he was in the #3 left turn lane when Unit 1 merged in front of him and
struck him. There was damage to the front bumper of the Prius and no airbags had been deployed.
Both vehicles were drivable and left the scene under their own power.
RCW 46.61.305.1 states: "(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."
Based on Jaliyah merging into an occupied turn lane I cited her for RCW 46.61.305 Unsafe Lane
Change under Sector citation #5A0563882. This citation should be mailed to Jaliyah.
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 7/30/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG 15799 CASE# 25-6565 DATE AND TIME i 07/30/25 11:26
OF COLLISION
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PAGE 4 OF 4