HomeMy WebLinkAbout25-7519 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG28204OLCERA
COLLISION REPORT 1591971
CASE# 25-7519 2
INTERSTATE CITY STREET❑ FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOC'AI-A`CENC'Y 42QQ 3
HIT&RUN CODING
❑ COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 1 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 03 STRUCK
RESERVATION : 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eOCL s on' 08 - 28 - 2025 1212 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
VUEMONT PL NE BLOCK ST e 300 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 F--1 MILES 1.1 FEET B S B W e
1 9 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4254455361 1 4 30
6 LAST NAME SPEKTOR FIRST NAME YEFIM MIDDLE t 1 2 31
INITIAL
STREET ❑ 558 MT BAKER PL NE CITY; RENTON ST I WA ZIP 980594490 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSP6RTED 3
INTERLOCKYEs No INTERLOCICvEs No YES F NO
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 12 - 22 - 1954 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
LICENSE, CSC3494 STATE WA VIN#; JN8AZ1MW8DW317353 3
10 F1 as ATP rt
TRAILER STATE TRAILER STATE
11 0 5 PLATE# PLATE# FROM TO
TRLR zRLR. 5 1 33
12 0 Q VIN#' VIN#
FROM TO
13 A VEH.YEARZOI3 MAKE NISS MODEL MURAN STYLE VEHICLETOWED2TOIyS46LIN ajWgYMEYERS VEHICLE m 34
DAMAGE IIII._IIII
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 4
14❑ LIABILITY INSURANCE NSURANCE CO TRAVELERS 616809456 203 1
IN EFFECT &POLICY#VEHICLE CHARGE 536
yes❑NO❑ CITATION# UR
15 sTANowc
UNIT 02 MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY PHONE DAM THR OLD MET
VEHICLE CYCLE nWNRR YES�/ NO
16❑
LAST NAME UNKNOWN FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY, RENTON ST ZIP ❑ 37
NEW ADDRESS
18❑ IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
CDL INTERLOCKYES No INTERLOCK YES NO vEs NO:
19 LICENS# STATE SEX U MMDDYY —� 39
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS AIRBAG 9 RESTR 9 EJECT 1 USE 9 CLASS 0 ❑
21 LICENSE CFV8267 TATE WA VIN# JTJGARDZ9L5017120 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2020 MAKE LEXS MODEL piJ($QQT STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO MARCO AURELIO P DE CARVALHO 300 VUEMONT PL NE APT F202 RENTON WA 98056 D:2066379497 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT &POLICY# t STOP
vewcLe ❑ CITATION
CHARGE to BOTTOM
EEGAEEY YES N10
25 a ' s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF
3000-348-189(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG28204
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7519
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.
C.ARNOLD 09-01-25 10:00 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 911512025 1:53:42 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 12:12 PM TIME POLICE ARRIVED i 12:15 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF F5
REPORT NO. EG28204 CASE# 25-7519 DATE OF COLLI r�510NN + 08/28/25 12:12
L1
NARRATIVE
CC 25-7519
On 8/28/2025 at 1212 hours I was dispatched to a motor vehicle collision at the Lexington Height
Apartments located at 300 Vuemont PI NE in the City of Renton, King County, Washington.
Pre-Collision
Driver 1 stated that he was in the drivers seat of Unit 1 within a parking stall at the Lexington Height
Apartments located at 300 Vuemont PI NE facing Northwest and began to have a medical
emergency, citing diabetes and low blood sugar.
Unit 2 was parked within a garage at the time of this collision to the Northwest of Unit 1's location.
Collision
Driver 1 stated that during the medical emergency, his foot slipped from the brake and onto the gas
and his vehicle moved forward over the curb, and then turning slightly to the left towards the garage
where Unit 2 was parked. Driver 1 stated that Unit 1 collided with the rear of the garage, forcing its
way through the wall, and then into the rear of Unit 2 where it came to rest.
It should be noted that the rear wall of the building that Unit 1 collided with sits beneath a degraded
hill, and that the front bumper of Unit 1 was at the height of around the top of the rear window of Unit
2 when the collision occurred.
When speaking with Driver 1, 1 did not notice any AOB of signs of drug use.
Injuries
Driver 1 did not have any complaint of injuries but was evaluated at the scene by Renton Fire
Authority (RFA) due to the medical emergency.
Vehicle Disposition
Unit 1 was towed out of the garage.
Final Disposition
Driver 1 suffered a medical emergency which resulted in a collision on private property.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer C. Arnold #12509 at 12:53 on 8/28/2025 in the City of Renton, King
County, Washington.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: MEDICAL EMERGENCY
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 5
SUPPLEMENTAL REPORT No. EG28204POLICE TRAFFIC
1 27
... ^'� COLLISION REPORT CASE# 25-7519
t113197
1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE
UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY 3
TYPE
2 ❑ 1 28
CARRIER
NAME
3 CARRIER L
ADDRESS
CITY ST ZIP
4 ❑ NAME # PLACARD
GWVR NAME IF NO NUMBER
SOURCE AXLES ' +
4a ❑ ADDITIONAL UNITS
'J MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE
UNIT# $ PEDESTRIAN �', YES� NO D:2535977226
5 VEHICLE CYCLE OWNER
29
LAST NAME CARIGAN FIRST NAME JENNIFER MIDDLE D
INITIAL
STREET 30
NEW AnnRFs'0: 19609 136TH STREET CT E CITY BONNEY LAKE ST WA ZiP gg391
6 PRESENT MEC7ICALTANSPORTED. 1 31
CDL IGNITION REQUIRED IGNITION :
INTERLOCK YES NO .:INTERLOCK YesLl NO rEs N
L
DRIVER'S STATE SEXF M�DDgY 07 - 01 - 1985
LICENSE
7
ON DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NAruREOFINJURIES
USE CLASS
8 ❑ 1 32
LICENSE rAT VIN
PLATE#
9 TRAILER I I TRAILER L
PLATE# STATE PLATE# STATE
0
10 ❑ TRLR TRLR
VIN.#. VIN#.
11 VEIL YEAR MAKE MODEL STYLE VEHICLE TOWE E T ABLIN TOWED BY G(,)V vEHICI F FROM To
DAMAGE YES NO YES NO
REGISTERED OWNER INFO. m 33
12 � SHADE IN DAMAGED AREA
4 FROM TO
LIABILITY INSURANCE❑ INSURANCE CO TOP
IN EFFECT &POLICY# 34
13 YES NO CITATION# CHARGE
1080TTOM
ecauv
s-rANoiNc
MOTOR PEDAL_ ' 1:1PROPERTY : DAMAGE THRESHOLD MET PHONE 35
14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO
36
15 LAST NAME FIRST NAME NIT AL
16 ❑ STREET �' CITY ST ZIP
NFW ADDRFSa
CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED
INTERLOCK YEs N{7 INTERLOCK YEs NO 'YES NO ❑
17 37
LICENSE#RIVERS — STATE SEX MD.00.B l
18 ❑
HELMET NJURY NATURE OF INJURIES 38
ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS
19 ❑ ❑ 39
LICENSE TAT viN#
PLATE#
20 TRAILER+ TRAILER 40
PLATE# STATE PLATE# STATE ❑
21 ❑ TRLR TRLR 41
VIN# VIN#Y
42
22 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED DUE T ABLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO YES NO El
23 REGISTERED OWNER INFO. SHADE IN DAMACED AREA 43
2 3 4
LIABILITY INSURANCE INSURANCE CO
IN EFFECT I &POLICY# ).c;Q
E. 44
vewc�e ❑ ❑ CITATION# CHARGE
24 I..EGALLY YES NO
STIWDING 8 3 G
1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 09-01-25 10:00 AM
25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED
26 BADGE 1 OR DD# 12509 O#RI WA0171300 APJACOBS 91115/2025
PAGE OF
3000-345-013(R 11/18)
REPORT NO. EG28204 CASE# 25-7519 DATE AND TIME 08/28/2512:12
OF COLLISION
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PAGE 5 OF 5