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Home My WebLink About25-6081 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c COLLISION REP FIT 1591971 SASE 25-6081 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 1 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 03 STRUCK RESERVATION z 3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 07 - 1-- 2025 1844 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ 116TH AVE SE BLOCK NO. e✓ 17600 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 100 00 FMILES N EET e S ❑B E e SEPETROVITSKYRD 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES NO D:2068548877 0 11 30 6� LAST NAME OTIS FIRSTNAME EMMA MIDDLE I M 1 1 2 31 INITIAL STREET ❑ 13536 SE 189TH PL CITY RENTON ST WA Zlp 98058 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/ 8❑ LRIIVER # 9❑ ON DUTY❑ STATUS' AIRBAG' 6 RESTR 4 EJECT 1 HUSEELMET 2 CLASS 7 UNKPAIN,I HEAIVYES MECHANISM z❑ ❑P1 ATE 14 CPX5264 sTAr WA v N# JM3KE4DY4F0513656 3 10 9❑ TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR. 5 1 33 12 2 5 VIN#' VIN# >; FROM TO ❑ VEH.YEAR 2015 MAZE) CX-5 SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN Tg YMEYERS GOVT.VEHICLE 5 1 34 13 4 DAMAGE YES No YES[:] No REGISTERED OWNER INFO CAMERON OTIS 13536 SE 189TH PL RENTON WA 98058 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 INSURANCE CO <�g3 4 14 IN EF IT INSURANCE ALL STATE 820809208IN EFFECT &POLICV# OPVEH" CHARGE TTOM 5 ❑ 36 LEGALLY YES❑NO❑ CITATION# 5A0675923 SPEED TOO FAST FOR CONDITIONS 5 15❑ STANDING 7 6 MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE UNIT 02 ❑ ❑ PEDESTRIAN ❑ ❑ D:2067793077 VEHICLE CYCLE OWNER YES�/ NO 16 a LAST NAME MAMON FIRST NAME DESTINY MIDDLE JA INITIAL 17 STREET I❑ 18605 132ND PL SE CITY' RENTON ST WA ZIP 98058 37 NEW ADDREss❑' 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YEs❑NOF,/ 19 LDI IVER # STATE WA ]SEX IF M .C... 08 _ 20 _ 2000 39 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40 ❑ 41 21❑ PLATE# CMS4930 TArE WA vIN 1 3MVDMBDLXNM449839 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ UIN#. 43 TRLR RLR 'IN#. TOWED BV GOV HI 44 VEH YEAR 2022 MAKE IlggZp MODEL CX-30 STYLE $D DAMAGE TOWED✓ NOO BLIN GENE MEYERS YES No�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE 8 POINSURGY#E CO FARMERS 543479328IN 1 9TOP —e E ❑ ,J� CITATION# CHARGE 25 i o BOTTOM LEGALLY YES N J $ ' =AS NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 GOODWIN 12884 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG33625 COLLISION REPORT III III III III III 111 1591972 CASE# 25-6081 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) MIRANDA CARLA R (LAST FIRST, ADDRESS&PHONE# 21412 STH PL S DES MOINES WA 98198 7876883840 SEXi F MMDOYyvv 07 - 02 - 1984 PASSENGER Z WITNESS UNIT# 3 POS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES USE 2 'CLASS '1 NAME (LAST,FIRST,MIDDLE INITIAL) WEISS BEN M ADDRESS&PHONE# D O B 21412 5TH PL S DES MOINES WA 98198 2084094614 SEX M MMDovvvv24 _ 1997 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 3 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1 NAME (LAST FIRST,MIDDLE INITIAL) MELLENTHIN JACOB M ADDRESS&PHONE# DES MOINES 2084069839 M 04 07 _ 1993 SEX D.O.B. MMDDYYYY PASSENGER WITNESS UNIT# ! 3 SEAT 7 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY NAT 1 URE 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. NICHOLAS GOODWIN 07-15-25 01:06 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 7691 1 101212025 4:51:07 AM BADGE OR ID# 12884 OR]# WA0171300 TIME POLICE DISPATCHED! 6:45 PM TIME POLICE ARRIVED i 6:50 PM FART I PAGE IT]OF 6� REPORT NO. EG33625 CASE# 25-6081 OF COLLISION 07/14/25 18:44 OF CbLLI510N NARRATIVE 25-6081 Unless otherwise noted, the following took place within the city limits of Renton, County of King, WA. On 07/14/2025 at approximately 1845 hours, I was dispatched to a rollover motor vehicle accident with injuries at the intersection of 116th Ave SE and SE Petrovitsky Rd. Dispatch advised "2 MVA - SUBJ STUCK IN VEH, INJS" and 1 VEH FLIPPED ON IT'S SIDE - BLU MAZDA CX5, PT IS CONSC, 20S YOF. NO OTHER INJS APPARENT. PSNGR SIDE AIRBAG DEPLOYED". I arrived on scene and observed the collision was just south of the intersection on 116th Ave SE. RRFA was already on scene. I positioned my vehicle just south of the intersection to block southbound traffic. As I approached, I observed several vehicles parked on the east side of the road, and then observed a vehicle, later identified as Vehicle 1, laying on the driver's side, blocking both the northbound and southbound lanes. I walked up to Vehicle 1, a 2015 Mazda CX-5, and observed the driver, later identified as Emma M. Otis (05/13/2008), who had unbuckled her seatbelt and was sitting upright on the driver's window. She appeared uninjured for the most part and was speaking with RRFA. I stepped away to allow RRFA to tend to Emma and began speaking with other involved. Officer Kearse spoke to Vehicle 2, a 2022 Mazda CX-30, who was driven by Destiny A Mamon (08/20/2000). Destiny was uninjured and relayed the following: Destiny was traveling northbound on 116th Ave SE and was approaching the intersection of SE Petrovitsky Rd. There were several vehicles in front of her as she neared the intersection, and traffic was moving slowly, as the light was red but had recently changed to green for traffic to continue northbound through the intersection. Destiny happened to look into her side mirror and observed Vehicle 1 speeding towards her. Destiny watched in her mirror as Vehicle 1 tried to swerve away at the last second but collided with the rear driver's side of her vehicle. Destiny then observed Vehicle 1 roll onto its side and come to a stop. I contacted Vehicle 3, a 2021 Mazda CX-9, driven by Dominik A Weiss (04/14/1991). Inside Vehicle 3 were three other passengers, the RO Carla R. Miranda (07/02/1984) in the front passenger seat, Ben M. Weiss (12/24/1997) in the right rear seat, and Jacob M. Mellenthin (04/07/1993) in the left rear seat. Vehicle 3 had damage to the rear hatch and bumper, and none of the occupants were complaining of injury. Speaking with Domink I gathered the following: Dominik and crew were traveling northbound on 116th Ave SE, directly in front of Vehicle 2. Dominik advised the same circumstances as Destiny in Vehicle 2; traffic was moving slowly as the light was red but just turned green for northbound traffic to proceed through the light. There were several vehicles in front of Vehicle 3. Dominik looked in his rearview mirror and observed Vehicle 1 traveling at a high rate of speed towards the slowed traffic. Dominik observed Vehicle 1 strike Vehicle 2, and then he watched as Vehicle 2 was pushed into his vehicle, striking the rear end. I spoke with a witness on scene, identified as Tobiah R. Ellis (06/11/1975). Tobiah advised he was facing southbound on the north side of the intersection. He was preparing to turn right and head westbound on SE Petrovitsky Rd, then observed the collision. Tobiah advised Vehicle 1 was traveling northbound at a high rate of speed, collided with Vehicle 2, and flipped on its side. He then drove south through the intersection and remained on scene to share the information. It appeared that Emma was treated on seen for minor injuries by RRFA but was not transported to the hospital after she was successfully extricated from her vehicle. Emma's parents arrived on scene and gave her a ride home. Gene Meyers towed both Vehicle 1 and Vehicle 2. Vehicle 2 sustained significant damage to the rear driver's side wheel and thus it was not drivable. Due to the statements from Vehicle 2 and 3, as well as the witness statement, in conjunction with the state of Vehicle 1, Emma M. Otis (05/13/2008) is receiving a citation for Basic Rule and Maximum Speeds (Speeds too fast for conditions) (RCW 46.61.400), for traveling at a rate of speed that was too fast for the traffic and road conditions. There were no signs of impairment and no other evidence to show Emma was distracted at the time of the collision. PAGE 3 OF 6 REPORT NO. EG33625 CASE# 25-6081 OF COLLISION 07/14/25 18:44 OF CbLLI510N NARRATIVE I provided all involved copies of the case number and exchange of information. Nothing further. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by Officer N. Goodwin 12884 at 0011 hours on 07/15/2025 in Renton, WA. PAGE 4 OF 6 SUPPLEMENTAL REPORT NO. EG336255 r`) POLICE TRAFFIC 1 1 8 27 COLLISION REPORT CASE# 25-6081 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USDOT ICC# VEHICLE TYPE CARGO BODY ;TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST ZIP—1 I ' 4 ❑ NAME # PLACARD: :❑ GWVR NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE I_) PEDESTRIAN OWNER YES NO D:2063116067 0 1 Zg LAST NAME : WEISS FIRST NAME DOMINIK MIDDLE A INITIAL STREET 30 NEW AnDRFSP' 21412 5TH PL S CITY DES MOINES ST WA ZIP 98198 6 ❑ 1 1 2 31 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YEs NO zERLOCK YES❑N0� YEs N DRIVER'S LICENSE STATE I WA SEX M MMDDYYv 04 - 14 - 1991 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 32 LICENSE I 70FBPS [TAT FL VIN# JM3TCACY9M0527608 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 2 5 VEH.YEAR2021 MAKE MAZD MODEL CX-9 STYLE SD I VEHICLE TOWS E T SABLIN TOWED BY anvi vEH1I' P FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFOCARLA MIRANDA 214125TH PL S DES MOINES WA 98198 D:7876883840 rj 1 33 12 � SHADE IN DAMAGED AREA 7 j FROM TO LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 966998087 q"i"Olx IN EFFECT &POLICY# 1 EHICLE 34 13 4 LEGALLY YES❑ NO❑ CITATION# CHARGE 0 BOTTUM STANDING } 8 7 14 ❑ UNIT Tr Vd 1RE O CYDCLE OWNERRTY YES AGE NOHRESHOLD MET PHONE 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE INITIAL TIAL ❑ STRE 16 NEW ETETnnR"Fl CITY ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED NTERLOCK YES No NTERLOCK YEs NO YES NO ❑ 17 4 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE CLASS 19 ❑ LICENSE rnr VIN# 39 PLATE# 20 ❑ TRAILER' STATE TRAILER STATE ❑ 40 PLATE#< PLATE# 21 ❑ ❑ 41 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VINE EFFECT &POLICY# i 970P - 4 E:l 44 24 LEwcLE YES❑ NO❑ CITATION# CHARGE iq 60TiOM LEC E STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. NICHOLAS GOODWIN 07-15-25 01:06 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 ORID# 12884 O#I',WA0171300 TIBEAU 101212025 PAGE F OF 6 3000-345-013(R 11118) REPORT NO. EG33625 CASE# ' 25-6081 DATE AND TIME 07/14/25 18:44 OF COLLISION s� 'a t a i s ljs� \ "G 4 rr a o' } c s� 0 s s PAGE 6 OF 6