HomeMy WebLinkAbout25-6571 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG15800OLCERA
COLLISION REPORT 1591971
ASE# 25-6571 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL A`OENCY. 4250 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TOTAL 1
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
GDLL.ISION'. 07 - 30 - 2025 1503 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
S 3RD ST BLOCK NO. e 200 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
0 4 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES NO ✓ O 1 30
6 LAST NAME UNKNOWN FIRST NAME MIDDLE 1 1 2 31
INITIAL
STREET F-1 CITY ST ZIP' 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYEs Nb YEs NO
8 LCEENSE# STATE SEX U MMDDYY+ -=- 1 2 32
9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 HELM
USEET 9 CLASS 0 NATURE OF INJURIES 2
LICENSE, 3
10� PI ATF# STATE V(N
TRAILER STATE TRAILER ,STATE
11 2 5 PLATE# PLATE# FBOM TO
TRLR rRLri 7 1 33
12 2 5 VIN# VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 3
TOWED By GOVT VEHICLE
13 1 SD DAMAGE YES f n O Z YES NO 34
REGISTERED OWNER INFO UNKNOWN VEHICLE NO. 1 ❑
IN EFFECT
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4
&POLICY# 4TOP
vEnic�E CHARGEt 5 36
Lemur YES❑NO❑ CITATION# 70 80TTOM
15❑ STM ING 7 e
11
�II
MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT Q2 VEHICLE CYCLE nWNFR YES�/ NO D:2067132498
16F]
LAST NAME KIRKHAM FIRST NAME EMMETT MIDDLE p
INITIAL
STREET ❑
17 14214 169TH AVE SE CITY RENTON ST, WA ZIP 98059 g 37
NEW ADDRESS
18� CDL IGNITION REQUIREO IGNTION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES NO jNTERLOXYEs DNO vES NOI
19 DRIVER'S STATE WA SEXI M D.O.B. 11 24 1944 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 40
LICENSEI
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 PLATE# CBL2770 rare W/a vIN# 1 FMCU94178KD58877 41
22❑ PLTL ATE# STATE TILER PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
TOWED BY GOV HI 44
VEH.YEAR 2008 MAKE FORD MODEL ESCAPE STYLE DAMIAGE TOWED No BLIN BANKERS ves No V
24
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 0859937-D24.47E
IN EFFECT &POLICY# 9TOP
vewae ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGnLLv YES N`LJ
25 a e
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. EG15800
COLLISION REPORT III III III III III 111
1591972 CASE# 25-6571
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.
C.ARNOLD 07-31-25 08:08 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY I DATE
RAYMOND GORAJEWSKI 12399 8/4/2025 8:27:23 AM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:06 PM TIME POLICE ARRIVED 3:16 PM
PART B 3oDo-345-,ao(Burls) PAGE 27 OF 47
REPORT NO.` EG15800 CASE# 25-6571 O COLLI COLLISION TIME
OF 07/30/25 15:03
COLLI
NARRATIVE
CC 25-6571
On 7/30/2025 at 1506 hours I was dispatched to a hit and run motor vehicle collision at the 200 block
of S 3rd St in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling East on S 3rd St in the #2 lane at around the 200 block.
Driver 1 fled the scene and was unable to provide comment.
Collision
Driver 2 stated that as he entered the 200 block, Unit 1 was in the #1 lane and attempted to perform a
lefthand turn from the outside lane in front of him. S 3rd St is a one way street that only travels
Eastbound. Driver 2 stated that the front drivers side bumper of Unit 1 collided with the front
passenger side bumper of Unit 2.
Driver 1 fled the scene last seen going South on Shattuck Ave S.
Injuries
No injuries reported.
Vehicle Disposition
Unit 2 was damaged to the extent that the front passenger side tire was pushed into the wheel well
and was rendered inoperable. Unit 2 was towed from the scene.
Final Disposition
Driver 2 stated that he would be able to identify Driver 2 if he saw here again, describing her as a
white female in her late 20's, blond hair, about 5'6", with a thin build. Driver 1 did commit the crime of
hit and run because she fled the scene after being involved in a collision resulting in only damage to
another vehicle. Driver 1 failed to provide the necessary information to satisfy the requirements of
RCW 46.52.020.
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 08:05 on 7/31/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG 15800 CASE# 25-6571 DATE AND TIME i 07/30/25 15:03
OF COLLISION
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