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HomeMy WebLinkAbout25-6459 iiTGiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG16650oc� RA COLLISION REPORT 1591971 CASE# 25-6459 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE LOL`CO A`CENC'Y 4200 3 COUNTY RD NVOLVED CODING 2 PRIVATE WAY ❑ TRIBAL UNITS TOTAL#OF TRUCK BJECT 1 28 01 TREE OR STUMP RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coulsfoN' 07 - 27 - 2025 2147 17 =.= S 8 W e IN 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION BLOCK NO. SE ROYAL HILLS DR 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 300 00 FEET e✓ S 8 E e CEDAR RIDGE DR SE 2 3 29 F MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE YES ✓NO 30 5 LAST NAME ROMAN CORNELIO FIRST NAME BARBARA MIDDLE E 1 1 2 31 INITIAL STREET 3315 JANE RUSSELLS WAY CITY TACOMA ST WA ZIP 98409 2 NEW AbDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs No✓ INTERLOCKYEs No✓ YES F No✓ $ DRIVECEN # STATE WA SEX F 11 MMDr YY' 03 — — 2006 32 9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 N USEET 2 1 INJURY CLASS 1 NAruRE of INJURIES 2 LICENSE, CPV1576 STATE WA VIN# WAUC4AFR6HA000410 3 10 as ATF tt TRAILER STATE TRAILER ,STATE 11 3 5 PLATE# PLATE# ROM TO rRLR TRLR 1 5 33 12 VIN# VIN ( FROM TO VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 v GOVT VEHICLE m 34 13 4 2017 AUDI S5 SD DAMAGE YES ONO d 9W9 MEYERS YEs� No✓ REGISTERED OWNER INFO ERIC SHKINDER 3000 SE ROYAL HILLS DR APT I6G RENTON WA 98058 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE[%/] NSURANCE CO AMERICAN FAMILY 411201760248 4 IN EFFECT &POLICY tt 9TOP CHARGE 5 36 Lemur yes❑NO❑ CITATION# 7 o BOTTOM 15❑ STMDNG a �y MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE UNIT©2 PEDESTRIAN VEHICLE CYCLE OWNER YES NO 16❑ LAST NAME FIRST NAME MIDDLE' INITIAL 17❑ STREET CITY ST ZIP 4❑ 37 NEW ADDRESS— 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38 INTERLOCKYEs No INTERLOCK YES0-001 YEs NOi 19 DCIENSE#VER' SEY MMDDYY -= E 39 HELMET I INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑ 21 PLATE#LICENSE — rarE vIN# 41 22❑ [TILER TRAILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP vemae ❑ ,.I—I CITATION# CHARGE tO BOTTOM A r YES N`LJ 25 s a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 KEVIN PETERSON 12808 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EG16650 COLLISION REPORT III III III III III 111 1591972 CASE# 25-6459 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) 'NAME (LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. - [----------� MMDDYYYY PASSENGER F-1 WITNESS El 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 I was dispatched to a collision on 07/27/25 at 2149 hours vehicle into a tree at SE Royal Hills DR and Cedar Ridge Dr SE, in city Renton, King County WA. Unit 1 CPV1576 Driver: Barbara E. Roman-Cornelio (DOB 03/11/2006) Upon arriving, I could see vehicle in the tree with the driver standing outside the vehicle. I spoke with the driver of Unit 1 who stated she had no injuries. She told me that she was traveling up the road in route to pickup her boyfriend that was at a friend's house. Upon driving up the hill she stated that a deer ran into the front end of her car. She then swerved off the road accelerating jumping the curve and hitting a tree. Unit 1 was given the case number as reference and the vehicle was towed. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 07/27/2025, 2348 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 07-27-25 11:55 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 8/6/2025 8:09:59 PM BADGE OR ID# 12808 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 9:49 PM TIME POLICE ARRIVED 9:53 PM PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37 REPORT NO. EG 16650 CASE# 25-6459 DATE AND TIME 07/27/25 21:47 OF COLLISION 3 d 1 r rs t PAGE 3 OF 3