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HomeMy WebLinkAbout25-8138 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG31031oc� RA ; COL-'J'®N RERT 1591971 ❑ FIRE ❑ CASE$� 25-8138 z 5 1 INTERSTATE CITY STREET ✓ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ VEHICLE ❑ LOCAL AGENCY 3 HIT&RUN C©DIN6 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# DATE OF N E IN eDLLISION' 09 - 18 - 2025 1719 17 =.= S 8 W E OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. MAPLE VALLEY HWY 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 FEET e S 8 W e MONROEAVESE OF 4 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:6613762609 0 4 30 6❑ LAST NAME AMAYA FIRST NAME RONALDO MIDDLE t 1 2 31 INITIAL STREET ] 4935 SHADOW STONE ST CITY; BAKERSFIELD ST CA Zlp; 93313 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO✓ INTERLOCKYEs NO✓ YES No Z 8 DCIENSE# STATE CA SEXI M MMDDYY' O6 - 20 - 1997 1 2 32 9� ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 NATURE of INJURIES 2= 10 PI ENSE 7PLZ239 STATE CA V 5YFBURHE8GP445507 3 STATE STATE TRAILER TRAILER 11 0 0 PLATE# PLATE# FROM To TRLR zRLR. 1 1 3 33 12 0 0 VIN#' VIN# FROM TO VEH.YEAR ZOI6 MAKE TO�. MODEL COROL STYLE SD VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE 7 1 34 13� DAMAGE YES II_II NO YESII_I) NO✓ [ijREGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 LIABILITY INSURANCE INSURANCE CO 14 AMERICAN FAMILY A104 4 94 6 85 IN EFFECT &POLICY#VEn" CHARGE 36 LEcLY YES❑NO❑ CITATION# <14, 15 STM ING MOTOR ✓ PEDAL- PEDESTRIAN1:1 PROPERTY DAM THR OLD MET PHONE UNIT O2 VEHICLE CYCLE nWNFR YES�/ NO D:4256153420 16� LAST NAME BANUELOS FIRST NAME RINGOBERTO MIDDLE INITIAL STREET ❑ 17 ❑ 18621 132ND PL SE CITY RENTON ST, WA ZIP 98058 q 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. 38 INTER(_OCKYES NO✓ [NTERLOCK YES 0Na✓ YES NO✓ 19 DRIVER'S STATE WA SEX M D.O.a. 12 03 1994 39 LICENSE# MMDDYY - 20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 1HELM USEET 2 CLASSY 1 NATURE OF INJURIES 40 21 LICENSE I PLATE# BBX8668 rare WA vIN# JFIVA1B67H9812533 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2017 MAKE $(JB,G MODEL (7/RX STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ NO✓ REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE[Z INSURANCE CO ALLSTATE 976578376 IN EFFECT &POLICY# I 1— L YES❑ N.I—I, CITATION# CHARGE 25 U�o LE L,—OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 E.EDMUNDS 12576 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG31031 COLLISION REPORT III III III III III 111 1591972 CASE# 25-8138 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 NJURY 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 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 CLASS NARRATIVE Unit 1 was stopped at a stop sign, turning left from Monroe Ave SE onto Maple Valley HWY eastbound.. Unit 2 was turning left from Maple Valley HWY onto Monroe Ave SE. Driver 1 stated he looked both ways and attempted make the left turn onto Maple Valley HWY. Driver 1 did not see Unit 2 making a left off of Maple Valley HWY and was unable to stop his vehicle before striking Unit 2. Both vehicle's sustained significant damage, rendering them unsafe to operate on the roadway and exceeding the state damage threshold. Fire was called to the scene as a precaution due to airbag deployment. After evaluation, neither driver required immediate treatment. Both driver's produced valid driver's license, registration, and proof of insurance. I created an exchange of information and gave a copy to both drivers. 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 E. Edmunds #12576 at 2026 on 09/18/2025 in Renton, WA. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. E.EDMUNDS 09-18-25 09:32 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 9/23/2025 8:13:26 PM BADGE OR ID# 12576 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:19 PM TIME POLICE ARRIVED i 5:19 PM PART B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EG31031 CASE# 25-8138 DATE AND TIME 09/18/2517:19 OF COLLISION t� n:. ti gkt 1{` k ty �ry � 3 t klt 4 S� z ay t'"b PAGE 3 OF 3