HomeMy WebLinkAbout25-7664 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG27036oc� RA
COLLISION REPORT 1591971
CASE# 25-7664 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 09 - 02 - 2025 1937 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOHARDYAVES MILE POST
e 600 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:8087471653 0 1 30
6 LAST NAME TOKA FIRST NAME SAMUEL MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 15914 44TH AVE W APT K104 CITY; LYNNWOOD ST I WA Zlp; 98087 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKYEs No YES D NO
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 08 - 08 - 2004 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 1 RESTR 4 EJECT 1 HELMET
6 CLASSY 1 [NATURE of INJURIES 2
LICENSE, C43279Z STATE WA VIN#; 1FTERIEHXNLD30895 3
10 Fq I PI ATP tt
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM To
TRLR zRLR 1 1 3 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2022 MAKE FORD MODEL RANGE STYLE TR VEHICLE TOWED fj TO ZBLIN TOWEDBY GOVT VEHICLE g 1 34
13 DAMAGE YES II_II NO YESII_] NO
REGISTERED OWNER INFO SAMUEL TOKA 1591444TH AVE WAPT K104 LYNNWOOD WA 98087 D:8087471653 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
2 LIABILITY INSURANCE INSURANCE CO 2 3
14 WASHINGTON NATION MUTUAL INS CPP1316764
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE t 5 36
Lemur YES❑NO❑ CITATION# 7 0 80TTOM
15❑ sTnNowc s 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:4259022941
16�
LAST NAME THOMAS FAIR FIRST NAME MITCHELL MIDDLE' /
INITIAL
17 F1 STREET ❑
❑ 7926 S 134TH ST CITY SEATTLE ST, WA ZIP 98178 q 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED fGNfTION PRESENT MEDICAL TRANS;P6RTED. 38
INTERLOCKYES ND INTERLOCK YES R NO YES No
19 DRIVERS STATE WA SEX M I D.O.B. 05 07 2004 � 39
LICENSE# MMDDYY —
20❑ ON DUTY STATUS AIRBAG 1 RESTR 4 EJECT 1 1HELM
USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 PATE# AAD9112 rare WA vIN# 2HKYF18433H577773 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2003 MAKE HOND MODEL PILOT EX STYLE LIT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO MITCHELL THOMAS FAIR 7926 S 134TH ST SEATTLE WA 98178 D:4259022941 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO PEMCO CA0768784
IN EFFECT &POLICY# 9TOP
HICL
L'EIL YES❑ NJ—I, CITATION11 CHARGE t080TTOM
VEE
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG27036
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7664
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 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
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.
KEITH PETTY 09-02-25 08:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 911012025 5:55:53 PM
BADGE OR ID# 12809 ORI# WA0171300 TIME POLICE DISPATCHED 1 7:39 PM TIME POLICE ARRIVED i 7:41 PM
PAST B a Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG27036 CASE# 25-7664 DATE OF COLLI r�510NN + 09/02/25 19:37
L1
NARRATIVE
25-7664
On 09/02/2025 at approximately 1939 hours, I was dispatched to the 700 block of Hardie Ave S in the
City of Renton, County of King, State of Washington for a collision with no injuries.
Upon arrival I confirmed there were no injuries from both parties.
I identified the unit 1 driver as Samuel Etinmet Toka (DOB 08/08/2004) by his WADL. Samuel was
driving a gray 2022 Ford Ranger (C43279Z/WA) VIN1 FTER1 EHXNLD30895, registered to Apex
Hood Cleaning out of Tumwater.
Unit 2 driver was identified as Mitchell James Thomas-Fair (DOB 05/07/2004) by his WADL. Mitchell
was driving his silver 2003 Honda Pilot (AAD9112/WA) VIN/2HKYF18433H577773.
Unit 2 was traveling north in the 600 block of Hardie Ave S while unit 1 was traveling south on Hardie
Ave S. Unit 1 attempted to turn left into the parking lot of 20 SW 7th St. Unit 1 did not see unit 2 and
pulled into unit 2's lane of travel. Unit 2 was unable to stop in time and collided into the rear
passenger side of unit 1.
Unit 1 had damage to the rear passenger side while unit 2 had damage to the front passenger side.
The damage is estimated to be over $1000. Both vehicles were able to drive away.
I provided the case number to both parties.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 09/02/25at 1913 hours, Place: Renton, King County, WA
PAGE 3 OF 4
REPORT NO. EG27036 CASE# 25-7664 DATE AND TIME 09/02/2519:37
OF COLLISION> '
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PAGE 4 OF 4