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HomeMy WebLinkAbout25-7944 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 25-7944 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3 HIT 8 RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#TRIBAL OF 02 OBJECT 1 1 8 28 UNITS RESERVATION I STRUCK z 3 DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cowsloN 09 - 11 - 2025 1820 17 ❑.❑ S H W H OF 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 140TH WAY SE BLOCK NO. e✓ 15205 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 585 00 FMILES N EET e S B E e MAPLE VALLEYHIGHWAY 0 4 29 MOTOR ✓ PEDAL- DAMAGETHRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO D:4062400287 0 1 30 6 LAST NAME MATHISEN FIRSTNAME COLLEEN MIDDLE R 1 1 2 31 INITIAL STREET ❑, 20701 CLUBHOUSE DR UNIT 205 CITY LEAVENWORTH ST WA 2jp, 988269185 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NOWINTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'F MID .O B 03 - 17 - 1957 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10 9❑ P1 aT�S� CJJ3471 sTArI WAVIN# JTEBU17R140051273 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FR.. ro TRLR. TRLR 7 1 33 12 0 0 VIN#' VIN#' FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 1 5 34 13 4 2004 TOYT 4RUNNE UT DAMAGE YES NO � g MEYER ves❑ No REGISTEREDOWNERINFO WILLIAM MATHISEN 20701 CLUBHOUSE DR UNIT 205 LEAVENWORTH INA 98826 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14� LIABILITY INSURANCE� INSURANCE CO TRAVELERS 614948125 2031 <1�3 4 LI EFFECT &POLICY# TOPVEHICLE CHARGE 36 LEGALLY res No clTAnoN# 5A0698058 FAIL YIELD PRIVATE RD MOTOR orroM 15❑ STANDING 7 6 MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE 16 a UNIT 02 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:4254160680 LAST NAME LABOY FIRST NAME ROBERTA MIDDLE L INITIAL 17 STREET❑ NEW ADOREss❑' 16205 131ST AVE SE CITY RENTON ST WA ZIP 980585513 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs I I NOF YES F% NO❑ 19[ DRIVER'S STATE WA ]SEX IF D.O.B. 07 22 _ 1975 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40 USE CLASS POSSIBLE CONCUSSION ❑ILICENSE 21❑ PLA E# AL V9667 TArE WA VIN# 1 FAFP42XX3F421786 41 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. N#. 43 RLR 'I VEH YEAR 2003 MAKE FORD MODEL MUSTAN STYLE CP VEHICLE TOWED TO BLIN TOWED ev GOV HI 44 24 DAMAGE YES NO GENE MEYER YES NO REGISTERED OWNER INFO ROBERTA LABOY16205131STAVESERENTONWA98058 VEHICLE NO.2 SHADEd DAMAGEDAREA 4� 3 4 LIABILITY INSURANCE INSU PORGY#E CO ENCOMPASS 2026733562IN STOP 5 VETILE ❑ ,J� CITATION# CHARGE 1oBOTTOM LEGALLY YES N`L J 25 ' a 7.1 -F NAME(PRINT) OFFICER PHONE BADGE OR ID# FENCY 26 Y NGUYEN 13182 A0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG28377 COLLISION REPORT III III III III III 111 1591972 CASE# 25-7944 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) REDMOND REBECCA (/AST FIRST, ADDRESS&PHONE# KENT WA 98032 2066192049 SEX' F MMDDYYYY PASSENGER WITNESS UNIT# f SEAT AIRBAG7 RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES O POS. USE CLASS NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# D O B SEX' MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B. MMDDYYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. 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. TIMOTHY NGUYEN 09-12-25 12:20 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 9/15/2025 10:40:32 PM BADGE OR ID# 13182 ORI# WA0171300 TIME POLICE DISPATCHED 6:25 PM TIME POLICE ARRIVED',6:31 PM PART PAGE IT]OF REPORT NO. EG28377 CASE# 25-7944 F LNa O 09/11/25 18:20 F coy�isI©�ON u NARRATIVE 25-7944 This incident was recorded with video and audio. Refer to this video for any exact quotations or for an exact sequence of events. The following is a summary of the events: On 09/11/2025, 1 was working as a Police Officer for the city of Renton. I was wearing a fully marked uniform and driving a fully marked vehicle. At approximately 1826 hours, I was dispatched to an injury accident at the 15205 block of 140th Way SE, within the city of Renton, King County, state of Washington. Upon arrival, I observed Vehicle 1 facing west in the southbound lanes of 140th Way SE. Vehicle 1 sustained heavy damage to the front end but did not have airbag deployment. I observed Vehicle 2 also facing west in the southbound lanes. Vehicle 2 sustained heavy damage to the front end and had a combination of airbags deployed. I interviewed Driver 1. In summary, Driver 1 was exiting a neighborhood located at 15205 140th Way SE. Driver 1 was facing eastbound out of the driveway and began turning left (northbound) onto 140th Way SE. Driver 1 thought that she had fully cleared the lanes of traffic before entering the roadway. Driver 1 evidently did not clear traffic and ultimately collided with Vehicle 2; however, she did not remember exactly how the collision occurred. Driver 1 stated she was wearing her seatbelt and that she was not injured. I interviewed Driver 2. In summary, Driver 2 was traveling southbound on 140th Way SE from Maple Valley Highway. Driver 2 was unsure if she was driving in lane two or three. Driver 2 stated that Vehicle 1 suddenly turned left (southbound) out of a neighborhood and in front of Driver 2. Driver 2 did not have enough time to stop and subsequently collided with Vehicle 1. Driver 2 stated that she was wearing her seatbelt. Driver 2 complained of general pain to the body and was later medically evaluated by Renton Fire Authority (RFA). RFA ultimately transported Driver 2 to Valley Medical Center, 400 S 43rd St for further evaluation. An assisting Officer interviewed Witness 1. In summary, Witness 1 was driving southbound on 140th Way SE from Maple Valley Highway. Witness 1 was driving in lane three directly behind Vehicle 2. Witness 1 observed Vehicle 1 suddenly turn left (southbound) out of a neighborhood directly in front of Vehicle 2, ultimately causing a collision. I exchanged information for Driver 1 and Driver 2. 1 also took photos of the scene and later uploaded them to Evidence.com. Based upon the totality of the circumstances, Driver 1 failed to yield to a motor vehicle while entering a highway from a driveway. I am issuing Driver 1: Infraction #5A0698058 for RCW 46.61.205.1 - FAIL TO YIELD PRIVATE RD MOTOR VEHICLE. This concludes my involvement on today's date. I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND ACCURATE AND THAT I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT. Signature: Officer T. Nguyen #13182 Date, Time, and Place: 09/11/2025 at approximately 2355 hours in the city of Renton, King County, PAGE 3 OF 5 REPORT NO. EG28377 CASE# 25-7944 F LNa O 09/11/25 18:20 F coy�isI©�ON u NARRATIVE state of Washington PAGE 4 OF 5 REPORT NO. EG28377 CASE# 25-7944 DATE AND TIME 09/11/2518:20 OF COLLISION ....... ... ...... .. .. .'� ...�1R NN5`w,'R�'0."Y�i`➢�$hS:�Ce'.?k}ehtN4?;(ah(53s` hJ�ti@h'F�S353�z4'il"i�Cs`�k{& 4z z 0 1> jo / , ''I'll 11 1 0" 3S AVM Hiot > r"", PAGE 5 OF 5