HomeMy WebLinkAbout25-7484 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG23402OLCERA
COLLISION REPORT 1591971
CASE# 25-7484 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOL`CODIOENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 2
3n M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s o v' 08 - 27 - 2025 0745 17 =.[� S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
RAYMOND AVE SW
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e SW 39TH ST
0 1 29
MOTOR PEDAL- DAM AG TSHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES NHREO ✓ 0 8 30
6 LAST NAME LIU FIRST NAME CLIVE MIDDLE K 1 1 2 31
INITIAL
STREET ] 7544 43RD AVE S UNIT D CITY; SEATTLE ST WA ZIP; 98118 2
NEW ADDRESS
7 +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES Na INTERLOCKVEs NO YES F No
DRIVERS# STATE WA SEX M MM0,13. 01 — 13 — 1988 t 1 2 32
8❑
9 ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT 9 N USEET CLASSY 0 NATURE of INJURIES 2
LICENSE, CLH2981 STATE WA VIN# WAUB4CF53RA082781 3
10 F PI ATP tt
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM To
TRLR rRLR. 5 1 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2024 MAKE AUDI MODEL S5 STYLE VEHICLE TOWED TO BLIN TOWED By GES VEHICLE 9 9 34
13 DAMAGE YES ✓ YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 4
14 GE/CO 6037975932
IN EFFECT &POLICY# 9TOP
vEn ' yes CHARGE t 5 36
IALLr ❑NO❑ CITATION# t a 60TTOM
15❑ STMDING s 7 e
UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 VEHICLE CYCLE nWNFR
16�
LAST NAME DELACRUZ FIRST NAME JOSE MIDDLE R
INITIAL
17 STREET ❑ 37
468 8TH AVE SE CITY EPHRATA ST, WA ZIP 988232239
NEW ADDRESS I I I I I 1
❑
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38
INTERLOCKYEs ND INTERLOCK YES NO YES NO
19� DRIVER'S STATE WA SEX'NI D.o.e. 04 29 1970 39
LICENSE# MMDDYY —
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG 2 RESTR LATEI4 EJECT 1 USE CLASS 1 ❑
21 LICEN E RP18936 rare WA vIN# 3AKNHLDRXPDNP1160 41
42
22❑ TRAILER 21540AL STATE WA TRAILER STATE
PLATE# PLATE#
43
VfN
23 RLR
UIN#. 'IN#
VEH.YEAR 2023 MAKE FRHT MODEL CASCADI STYLE TR VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO SKAGIT INC 16159 MCLEAN RD MOUNT VERNON WA 98273 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO NATIONAL INTERSTATE INSURANCE CO.WPP8200065.06
IN EFFECT &POLICY# I STOP
1—
— YESZ N,J—I CITATION11 CHARGE to BOTTOM
LE
L,G
25 s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG23402
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7484
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
POS. ' USE GLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
: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 08-27-25 11:07 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
C.JACOBS 1953 8/28/2025 2:25:45 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 8:19 AM TIME POLICE ARRIVED i 8:37 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF F5
REPORT NO. EG23402 CASE# 25-7484 DATE AND TIME +OF COLLISION 08/27/25 07:45
NARRATIVE
CC 25-7484
On 8/27/2025 at 0819 hours I was dispatched to a motor vehicle collision at the intersection of SW
39th St and Raymond Ave SW in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was facing North on Raymon Ave SW and stopped for a stop sign, preparing
to perform a lefthand turn to proceed West on SW 39th St.
Driver 1 had exchanged information and was unavailable for interview. I was unable to locate a
phone number for Driver 1.
Collision
Driver 2 stated that while stopped, Unit 1 approached from behind and the front passenger side
bumper of Unit 1 collided with the rear drivers side corner of Unit 2's trailer.
Injuries
None reported.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I was unable to interview Driver 1 and there was no video present. Given this, I am unable to
determine proximate cause. This collision is below the reportable threshold and was requested by
Driver 2 per his employer.
I 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 11:07 on 8/27/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EG23402POLICE TRAFFIC
1 27
... ^'� COLLISION REPORT CASE# 25-7484
t113197
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE ✓
UNIT# 2 USDOT 705345 ICC# VEHICLE TYPE 1 4 1 CAR7GO BODY 2
2 ❑ 1 28
CARRIER NAME. SKAGIT TRANSPORTATION INC
. .::.
3 CARRIER L
ADDRESS 16159 MCLEAN RD
C17Y MOUNT VERNON I ST WA ZIP 98273
4 ❑ NAME # PLACARD.
NAME IF NO NUMBER
SOURCE 1 1 1 AXLES 08 GWVR 104000 +
4a ❑ ADDITIONAL UNITS
UNIT# MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE
5 ❑ VEHICLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNER ❑'. YES NO
MIDDLE 29
LAST NAME FIRST NAME INITIAL
STREET 30
CITY ST ZIP
NEW ARI3RFfi .
6 ❑ CDL GNITION REQUIRED PRESENT MEDICALTANSPORTED' 1 31
I 1{iNiTION ::
INTERLOCK YES NC INTERLOCK YES No YES NOD
LICENSE STATE SEX MMDDDYBY
7
ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
USE CLASS
8 ❑ 1 32
LICENSE TAT UIN.
PLATE#
9 TRAILER TRAILER 2
PLATE# STATE PLATE# STATE
0
10 ❑ TRLR TRLR
VIN.# VIN#.
11 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWE E T ABLIN TOWED BY GOVT.VFHICI F FROM TO
DAMAGE YES NO YES NO
m 33
REGISTERED OWNER INFO.� SHADE IN DAMAGED AREA
12
LIABILITY INSURANCE❑ INSURANCE CO TOP 4 FROM TO
IN EFFECT &POLICY# I """" S m 34
13 vewcEe YES NO[jj CITATION# CHARGE
1080TTOM
ecauv
sTANoINc
MOTOR PEDAL_ ' 1:1PROPERTY : DAMAGE THRESHOLD MET PHONE 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
36
15 LAST NAME FIRST NAME IN L
16 ❑ STREET �' CITY ST ZIP
NFW AODREsa
CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTANSPORTED
INTERLOCK YES NO INTERLOCK YES NO 'YES NO
17 37
RIVERSLLIICENSE# STATE SEX M..YB _
18 ❑
HELMET INJURY: NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS.
19 ❑ ❑ 39
LICENSE TAT vIN#
PLATE#
20 TRAILER+ TRAILER 40
PLATE#.: STATE PLATE# STATE ❑
21 ❑ TRLR TRLR 41
VIN# VIN#Y
42
22 VIER.YEAR MAKE MODEL STYLE VEHICLE TOWED DUE T SABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO El
23 REGISTERED OWNER INFO. SHADE IN DAMAC ED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT I &POLICY# 1K-99
y. 44
vewcEe ❑ ❑ CITATION# CHARGE 24 IEGALLY YES NO3 3 G
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 08-27-25 11:07 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 BADGE 1 OR DD# 12509 O#RI WA0171300 APJACOBS 8/228/2025
PAGE OF
3000-345-013(R 11t18)
REPORT NO. EG23402 CASE# 25-7484 DATE AND TIME 08/27/2507:45
OF COLLISION> '
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PAGE 5 OF 5