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HomeMy WebLinkAbout25-7473 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG25418OLCERA COLLISION REPORT 1591971 ❑ FIRE I �/�$E$ 25-7473 2 0 5 INTERSTATE CITY STREET ✓ RESULTEDSTATE ROUTE OTHER STOLEN vEwCLE LOCALAGENCY 3 HIT&RUN C©DIN6 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# eaCL s on' 08 - 26 - 2025 1930 17 =.[� S 8 W e OF IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. e .� 4a SB 1405 MILE POST ❑ ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 1.1 FEET e S 8 W e N SOUTHPORT DR 0 1 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2064529386 0 4 30 6 LAST NAME SILVA FIRST NAME ANGELA MIDDLE t 1 2 31 INITIAL STREET ] 1190 UNION AVE NE APT E2 CITY; RENTON ST I WA Zlp; 98059 2 NEW ADDRESS 7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES NO✓ INTERLOCK YES N©✓ YES NO✓ 8 DRIVER # STATE WA SEXI F MMDDYY' 04 - 08 - 2004 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 3 RESTR 4 EJECT 1 HELMET 2 CLASSY 1 [NATURE of INJURIES 2 LICENSE, CFP4794 STATE WA VIN#; 2HGFC2F51GH537516 3 10 Fl I as ATP tt TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# ROM To TRLR TRLR. 3 7 33 12 0 0 VIN#' VIN# FROM TO 13 4 VEH.YEAR2016 MAKE HOND MODEL civic STYLE SD VEHICLE TOYED NO�iS46LIN Tv4 EBYMEYERS GOSI-`-I VEHICLE NO✓ 1 3 34 DAMAGE IIII._IIII I�I REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE R 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 4 14 PROGRESSIVE 8615t8616 IN EFFECT &POLICY# 9TOP VEn" CHARGE 5 36 LEGALLY YES❑NO❑ CITATION# t a 80TTOM 15❑ STANDING 7 e MOTCYR ✓ PEDAL- PEDESTRIAN1:1 PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:4252698973 16� LAST NAME FREY FIRST NAME STEPHEN MIDDLE E INITIAL 17 F1 STREET ❑ ❑ 1717 MONROE AVE NE CITY' RENTON ST, WA ZIP 98056 4 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYES NO✓ INTERLOCK YES ND✓ vEs NO✓ 19 DRIVER'S MMDDYY 20❑ ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40 21 LICENSE CMS5772 TATe WA VIN# 2HKRS6H50RH810216 41 22❑ PLATE# STATE PLATE# STATE 42 23 TRLR r RLR 43 UIN#. 'IN# VEH.YEAR 2Q24 MAKE HOND MODEL (,`R-�/ STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES �/ No GENE MEYERS E No✓ REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE[Z INSURANCE CO ALL STATE 987640399 IN EFFECT &POLICY#Y 1—LEGALLY YES❑ N,JI CITATION# CHARGE UR `.LJ25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 E.EDMUNDS 12576 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG25418 COLLISION REPORT III III III III III 111 1591972 CASE# 25-7473 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 NJURY NATURE OF INJURIES POS. ' USE CLASS 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 Unit 2 was making a left turn, on a green light, from SB 1405 onto eastbound N southport Dr. Unit 1 was traveling southwest bound on N Southport Dr, approaching a red light. Driver 1 stated an object in her car rolled under her brake pedal, preventing her from depressing it intime to stop at the light. The front end of Unit 1 struck the front end of Unit 2 causing significant damage to both vehicles. Neither driver was immediately injured in the collision. Both drivers provided valid WA driver's license, vehicle registration, and proof of insurance. I provided an exchange of information to both parties. Firefighters were called to the scene as a precaution due to unit 1's airbag deployment. Both vehicles were towed from the scene and appeared to meet the damage threshold. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer E. Edmunds/#12576, on 08/26/2025 at 2017 hours in Renton, Washington. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. E.EDMUNDS 08-26-25 08:32 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 9/4/2025 2:46:03 PM BADGE OR ID# 12576 ORI# WA0171300 TIME POLICE DISPATCHED 1 7:30 Pry] TIME POLICE ARRIVED i 7:30 PM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EG25418 CASE# 25-7473 DATE AND TIME 08/26/2519:30 OF COLLISION 1• � v r rrt �r, V y 1, y i% t S Y*' � e a � 5 t xr s r \ 4 G 4 Xi t � � r. r SC 1\ 4 w"� F j� ry PAGE 3 OF 3