HomeMy WebLinkAbout25-7298 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG23400OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-7298 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOL`CODIGENC'Y 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UMTS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E IN eDL�ISION' 08 - 21 - 2025 1134 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e 400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 3 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4255706537 0 1 30
g LAST NAME RODRIGUEZ FIRST NAME ANTONIO MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 2200 196TH ST SE UNIT 20 CITY; BOTHELL ST WA I ZIP; 980127228 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKYEs NC YES F NO
8❑ DCIENSE# STATE WA SEXI M MMDDYY' O6 — 26 — 1996 1 2 32
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE OF INJURIES 2
USE CLASS FACEINECKILEG PAIN
LICENSE, CTZ3953 STATE WA VIN# 1G1ZD5ST3NF138676 3
10[9� as ATP tt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR zRLR. 3 1 33
12 3 5 VIN# vIN#
FROM TO
13 3 VEH.YEAR2022 MAKE CHEV MODEL MALIBU STYLE VEHICLE TOYED NO�iS46LIN Tv4 EBYMEYERS GESVT r`-I EH-
p 5 1 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
$ INSURANCE CO 3 4
14 LIABILITY INSURANCE PROGRESSIVE 999821230
IN EFFECT &POLICY# 9TOP
VEn" CHARGE 7080TTOM 5 36
15
Lrn Lyc YES❑NO❑ CITATION# 5A0625720,5A0625720 IMPROPER LANE USAGE,NO VALID e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:2066931107
16�
LAST NAME MACH FIRST NAME TOAN MIDDLE' P
INITIAL
17
STREET ❑ 37
NEW ADORE SS❑ 1901 194TH ST E CITY SPANAWAY ST, WA ZIP 983873427
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES No INTERLOCK YES NO ves NO'
19 DRIVER'S STATE WA SEX M D.O.e. 02 07 1971 39
LICENSE# MMDDYY
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG g RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE PATE# CSK8441 rare WA vIN# JFIZNBE17S8756120 41
22❑ STATE PLAAILER TE# STATE 42
PLATE#
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2Q25 MAKE TOYT MODEL GR 86 STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YES �/ No GENE MEYERS vEs ND�/
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADFY DAGED AREA
4
LIABILITY INSURANCE INSURANCECO STATE FARM 5828898-E27.47
IN EFFECT &POLICY# t
vaE JL—JI CITATION# CHARGE
25 EwEEY YES❑ N U;0, D
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG23400
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7298
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) GERST ANN M
ADDRESS&PHONE N,
111 CEDAR STAPT 509 SEATTLE WA 981212270 SEXi F MMDooYBYYY 11 IT
24 - 1989
SEAT HELMET I INJURY NATURE OF INJURIES
PASSENGER Z WITNESS UNIT# 1 POS. 3 AIRBAG 6 RESTR. 4 EJECT 1 USE CLASS ;7 FACE AND LEG PAIN
:NAME
(Lnsr EIRST,MIDDLE INITIAL) i MACH TYLER N
ADDRESS&PHONE*
1901 194TH ST E SPANAINAY WA 98387 SEX' M D D e 01 _ 14 _ 2016
MMDDYYYY
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER a WITNESS UNIT# 2 SOS. ' 3 AIRBAG 9 RESTR. 4 EJECT 1 USE WARS 1 ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I 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 08-21-25 12:42 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 8/28/2025 2:18:51 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 11:37 AM TIME POLICE ARRIVED i 11:39 AM
PAST B 3 Do-3mx-attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG23400 CASE# 25_7298 O OF COLLISION TIME 08/21/25 11:34
NARRATIVE
CC 25-7298
On 8/21/2025 at 1137 hours I was dispatched to a motor vehicle collision at around the 400 block of
Rainier Ave S in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling North on Rainier Ave S in the #3 lane at around the 400 block.
Driver 1 stated that he was in the McLendon's parking lot facing West at around the 400 block of
Rainier Ave S preparing to perform a righthand turn to proceed North on Rainier Ave S.
Collision
Driver 2 stated that as he entered the 400 block, Unit 1 emerged from the parking lot and across
lanes #1 and #2. Driver 2 stated that Unit 1 began to enter lane #3 next to him which forced him to
make a correction to maneuver left. Driver 2 stated that he overcorrected and the drivers side tires of
Unit 2 collided with the curb, forcing Unit 2 back into lane #3 and the passenger side of Unit 2 collided
with the drivers side of Unit 1. This forced Unit 1 to lose control and sharply turn right where Unit 1
went off of the roadway, over the sidewalk, and into a barrier.
Driver 1 stated that as he exited the McLendon's parking lot to proceed North, he entered the #1 lane,
then merged to the #2 lane. Driver 1 stated that he was unsure whether he entered lane #3 while
doing this and that he did not see Unit 2. Driver 1 stated that the passenger side of Unit 2 collided
with the drivers side of Unit 1, then forcing Unit 1 to turn sharply to the right and off of the roadway
into a barrier.
Driver 1 provided me with an ID card and upon a check of DOL his driving status was "Not Licensed -
Eligible".
Injuries
Driver 1 and his passenger complained of leg pain and facial pain from airbags. Driver 1 and his
passenger were treated at the scene but refused transport.
Vehicle Disposition
Both vehicles were towed from the scene.
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 failed to do this when he entered lane #3 forcing Unit 2 into the curb.
Driver 1 was cited per RCW 46.61.140 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 12:37 on 8/21/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG23400 CASE# 25-7298 DATE AND TIME 08/21/25 11:34
OF COLLISION> '
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