HomeMy WebLinkAbout25-7528 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG27218oc� RA
COLLISION REPORT 1591971
CASE# 25-7528 2
INTERSTATE CITY STREET FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 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 - 28 - 2025 1714 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 4TH ST BLOCK NO.
4a❑
MILE POST e
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------ 1.1 FEET e S 8 W e PELLYAVE N
0 4 29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:5705793549 0 1 30
5 LAST NAME HOLLIS FIRST NAME KHEENAN MIDDLE D 1 1 2 31
INITIAL
STREET ] 8156 12TH AVE SW
NEW ADDRESS CITY I $EATTLE ST WA ZIP: 98109 2
7 +CDL IGNITION REQUIRED IGNITION PENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO%/ INTERLOCK VEsRES No�/ YES F NDF,/
DCIENSE# STATE SC SEXI M MMDDYY' 09 — 14 — 1996 t 1 2 32
8❑
9 ON DUTY STATUS' AIRBAG 2 RESTR 9 EJECT 1 N USEET CLASSY ? NATURE of INJURIES 2=
LICENSE, C96160T STATE WA V # NMOLS7E2XK1428517 3
10� PI ATP rt
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM To
TRLR zRLR. 3 1 5 33
12 0 Q UIN#' VIN#
FROM TO
VEH.YEAR 2019 MAKE FORD MODEL TRAN$I STYLE VN VEHICLE TOWED fj TO ZBLIN TOWED BY GOVT VEHICLE 3 7 34
13 DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO ZIONS CREDIT CORPORATION PO BOX 3954 SALT LAKE CITY UT 84110 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 NSURANCECO 3 4
14 LIABILITY INSURANCE MILFORD CASUALTY INSURANCE COMPANY MPP103214700
IN EFFECT &POLICY# 4TOP _
sVEHICLE rgNo NG ❑ ❑ 5AO742993 CHARGE PROHAMPROPER TURN o ooTrofi 36
YES[:]NO CITATION#
15
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:5038692569
16�
LAST NAME DETHLEFS FIRST NAME AARON MIDDLE
INITIAL
17 STREET ❑
❑ 11400 SE 147TH AVE CITY CLACKAMAS ST OR ZIP 97015 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTEDi ❑ 38
INTERLOCKYEs NO INTERLOCK YES NO vEs No
19 DRIVER'S STATE WA SEX M D.O.e. 1? 25 ?993 39
LICENSE# MMDDYY
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG g RESTR g EJECT 1 USE CLASS ? ❑
21 LICENSE
PLATE# 415MB8 TATE OR VIN# JF1 VA2W64J9823687 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 201$ MAKE $(JBp MODEL (7/RX STYLE qp VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO UNITUS COMMUNITY CREDIT U PO BOX 277908 SACRAMENTO CA 95827 VEHICLE NO.2
SHADE IN DA GF AREA
2
LIABILITY INSURANCE INSURANCECO CINCINNATI INSURANCE COMPANY 0244.10677
IN EFFECT &POLICY# 9TOP
vewcLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGAILY YES No
25 a E
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
LACY SMITH 12613 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG27218
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7528
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 CIASS ----�
: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 GLASS
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.
LACY SMITH 09-10-25 01:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 911112025 11:36:07 AM
BADGE OR ID# 12613 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:21 PM TIME POLICE ARRIVED i 5:Y8 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO.` EG27218 CASE# 25-7528 DATE OF COLLI r�510NN + 08/28/25 17:14
L1
NARRATIVE
On 08/28/2025, 1 was assigned to District 22 as the, 1 R22. At approximately 1721 hours, I was
dispatched to N 4TH ST/PELLY AVE N for a two vehicle collision. This incident occurred in the City of
Renton, County of King, State of Washington.
Unit 1- WA/C96160T
Unit 2- OR/415MBB
I arrived on scene and contacted the driver and sole occupant of unit 1. 1 positively identified him as
Kheenan Daniel Hollis, via the physicals from his South Carolina DOL return. Hollis stated he was
traveling westbound on N 4th ST and he attempted to make a left hand turn onto Pelly Ave N. Hollis
admitted he was in both lane 1 and lane 2 when he attempted to make the turn on to Pelly AVE N, but
he insisted unit 2 sped up and was driving too fast.
I then contacted the driver and sole occupant of unit 2. 1 positively identified him as Aaron Dethlefs,
via his Washington State Driver's license. Dethlefs stated he was traveling westbound on N 4th St
when unit 1 turned into the passenger side of his vehicle.
I observed damage to the passenger side of unit 2 as well as damage to the front drivers side bumper
of unit 1. No injuries were reported from this incident.
Based on the statements made by both drivers and the evidence on scene, it appears that unit 1
attempted to make an illegal left turn from lane two and collided with unit 2, who was already
occupying lane 1.
Kheenan Daniel Hollis was cited for RCW 46.61.290 due to the fact that he did not approach the turn
in the extreme left-hand lane lawfully available to traffic moving in the direction of travel of the vehicle
and collided into unit 2, who was already occupying lane 1. Citation 5A0742993.
During this incident, I was equipped with a body-worn camera, which records both audio and video.
Portions of this incident were recorded. This report is merely a summary of the incident and is not
intended to be an exact transcription of the entire investigation or what may have been captured with
the recording system.
PAGE 3 OF 4
REPORT NO. EG27218 CASE# 25-7528 DATE AND TIME 08/28/2517:14
OF COLLISION> '
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