HomeMy WebLinkAbout25-8527 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 25-8527 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ HIT F ❑ LOCAL AOENC 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 7 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GowsloN 10 - 01 - 2025 1629 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 800
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2534496006 30
6� LAST NAME DELGARDO FIRSTNAME GREGORY MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 9551 RAINIER AVE S APT 107 CITY SEATTLE ST WA ZIP 981186048 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATFBit BSA5709 sTArr WA VIN#' JN16J1CR4JW281646
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM ro
TRLR. TRLR. 7 3 33
12❑ VIN#' VIN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13FAl 2018 NISS ROGUE DAMAGE YES NO YES❑ No✓
REGISTERED OWNER INFO GREGORY DELGARDO 9551 RAINIER AVE S APT 107 SEATTLE WA 981186048 D:2534496006 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 UABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VE'CLE CHARGE 5 36
LEcnLLv YES❑NO❑ CITATION# 10 BOTTOM
15❑ TANDING 8 6
MOTOR PEDAL ,� PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:7349347234
16 a
LAST NAME VAN SICKLE FIRST NAME DAVID MIDDLE A
INITIAL
17❑ STREET ❑', 4308 E F ST CITY' TACOMA ST WA ZIP 984041456 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICALt-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NoF YES t l NO❑
19 DRIVE # STATE SEX M M .C... 02 _ 12 _ 1996 El 39
ON DUTY STATUS 1 AIRBAG RESTR EJECT 3 WEB MEET 9 IN [NATURE Sy 7 L LEG L SHOULDER L ARM R ARM 40
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N`L J
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 4 9 M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG33742
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8527
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BRIEMAIER BEN
(LAST FIRST,
ADDRESS&PHONE# D.O.B.
5074690009 SEX' U MMDDYYYY -❑
PASSENGER WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ � POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O I
SEX MMD DO V
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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.
M.LEVERTON 10-02-25 07:28 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
RAYMOND GORAJEWSKI 12399 101212025 8:29:34 AM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 4:29 PM TIME POLICE ARRIVED:4:30 PM
PART I PAGE IT]OF 4�
REPORT NO. EG33742 CASE# 25-8527 OF COLLISION
10/01/25 16:29
OF CbLLI510N
NARRATIVE
sidewalk-tbone
Within the city limits of Renton/King/Wa I responded to a car vs bicycle crash at the 800 block of S
Grady Way in the parking lot of Arco-AM/PM.
I contacted the driver of unit 1 who told me he was in the parking lot eastbound towards the driveway
at Talbot Rd S. He told me he saw a bicycle rider northbound on sidewalk and noticed this as he was
approaching the driveway apron. He told me he applied his brakes to avoid contact. He told me it
appeared to him the bicycle rider stopped suddenly as well and tipped over. Unit 1 told me he did not
have contact with the bike. He and I were unable to find any evidence of contact. He did not
complain of injury.
I contacted the bicycle rider who had been treated by Renton Fire on scene. He was released after a
check for complaint of injuries. He told me he was on the west sidewalk northbound. He told me he
was hit by unit 1 and knocked over. He told me there may or may be damage to his batteries that
could be over 500$ a piece.
I looked closely at his bicycle and did not notice any significant damage. I contacted the witness by
phone. Wit told me he was about 75' away and did not actually see the units contact. But did see the
bicycle rider fall to the side near the front of unit 1. He told me he stopped to offer help and provided
his phone number.
Information/insurance only.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 10/2/2025
PAGE 3 OF 4
REPORT NO. EG33742 CASE# 25-8527 DATE AND TIME 10/01/2516:29
OF COLLISION
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PAGE 4 OF 4