HomeMy WebLinkAbout25-7061 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG27029oc� RA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-7061 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCCODIGENC'Y 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' 08 - 13 - 2025 1634 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e 100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 25 00 FEET e✓ e AIRPORT WAY
S 8 W
2 0 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:4258294368 0 1 30
5❑ LAST NAME CORDOVA RAMOS FIRST NAME PATRICIA MIDDLE t 1 2 31
INITIAL
STREET ❑ 1319 S PUGET DR APT D11 CITY; RENTON ST WA ZIP; 98055 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs D No INTERLOCKVEs Na YES NO
DRIVER # STATE WA SEXI F MMDDYY' 10 31- - 1968 t 1 2 32
8❑
9 ON DUTY STATUS' AIRBAG 1 RESTR 4 EJECT 1 HELM
USEET 6 CLASSY 1 NATURE of INJURIES 2
10 LI ENSE' D17036F STATE WA VIN# JALE5B14527902608 3
TRAILER STATE TRAILER STATE ROM To 11 0 0 PLATE# PLATE#
TRLR TRLR. 3 7 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2002 MAKE ISU MODEL NQR STYLE V Y EHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO `/ YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 2 4
14 TRAVELERS CASUALTY At182355-BA
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE t 5 36
Lemur YES❑NO❑ CITATION# 70¢OTTOM
15❑ sTnNowc s 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:9712190689
16�
LAST NAME STORER FIRST NAME CASEY MIDDLE D
INITIAL
17 F1 STREET ❑
❑ 8427 S 123RD P! CITY SEATTLE ST, WA ZIP 98178 q 37
NEW ADDRESS
18❑ IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCKYES ND tNTERLOCKYEs No
19 DRIVERS ' STATE WA SEX M I D.o.B. 09 01 1981 � 39
LICENSE# MMDDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H EL 6 CLASSY 1 NATURE OF INJURIES 40
21 LICENSE C32919A TATe WA VIN# 2GCEC19T411116047 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2001 MAKE CHEV MODEL SIlVERA STYLE pi( VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 988937206
IN EFFECT &POLICY# t STOP
YEmae ❑ N`.L J
,.I—I CITATION# CHARGE to BOTTOM
25 EEEILY YES7KEH
'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
PETTY 12809 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG27029
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7061
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 08-13-25 07:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 911012025 5:58:53 PM
BADGE OR ID# 12809 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:38 PM TIME POLICE ARRIVED i 4:54 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG27029 CASE# 25-7061 DATE OF COLLI r�510NN + 08/13/25 16:34
L1
NARRATIVE
25-7061
On 08/13/2025 at approximately 1638 hours, 1 was dispatched to 251 Ranier Ave N , within the City
Limits of Renton, County of King, State of Washington for a non-injury collision
Upon arrival, I contacted the involved parties and confirmed no injuries had occurred requiring
immediate medical response at the time of report. There, I collected the driving documents of the
involved parties and their independent recollections of the events leading up to the collision.
Unit 1 driver was Patricia Cordova Ramos (DOB 10/31/1968), identified by her WADL. Patricia was
driving her white 2002 Isuzu NQR (D17036F/WA) VIN/JALE5B14527902608 box truck.
Unit 2 driver was Casey Dale Storer (DOB 09/01/1981), identified by his WADL. Casey was driving
his 2001 gray Chevy Silverado (C32919A/WA) VIN/2GCEC19T411116047.
Unit 2 stated he was heading west on Airport Way in lane 1. As he crossed over Rainier Ave S, unit 1
merged into his lane and collided with the side of his truck. The damage was valued at over $1000.
Unit 1 agreed with the version of events that Unit 2 described.
Based on my observation of the collision, 1 determined that the Driver of Unit#1 (Patricia Cordova
Ramos) is the proximate cause of the collision due to the unsafe lane change.
I provided an exchange of information for both parties, with each of their contact information and case
number.
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: 08/13/25t 1750 hours, Place: Renton, King County, WA
PAGE 3 OF 4
REPORT NO. EG27029 CASE# 25-7061 DATE AND TIME 08/13/2516:34
OF COLLISION
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