HomeMy WebLinkAbout25-8332 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG33060OLCERA
COLLISION REPORT 1591971
CASE# 25-8332 2
INTERSTATE CITY STREET❑ FIRE I
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOL'AI-A`GENC'Y 4200 3
HIT&RUN CODING
❑ COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 09 - 25 - 2025 1512 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
HOUSER WAY N BLOCK NO. e 485 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 1 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2064036813 0 6 30
6 LAST NAME BROWN FIRST NAME ANTHONY MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 20708 123RD PL SE CITY; KENT ST WA ZIP; 980311678 2
NEW ADDRESS
7 COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES No INTERLOCKYEs NO YES F NO
8 DRIVERCENS # STATE WA SEXI M MMDDYY' O6 - 13 - 1983 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RE
4 EJECT 1 N USE CLASSY 1 [NATURE of INJURIES 2
10 LI ENSE' D55360H STATE WA VIN# 2HJYK16577H528867 3
TRAILER STATE TRAILER STATE ROM To 11 0 0 PLATE# PLATE#
TRLR rRLR. 1 1 5 33
12 0 0 VIN#' VIN#
FROM TO
13 4 VEH.YEAR2007 MAKE HOND MODEL RIDGELI STYLE VEHICLE TOYED NO�iS46LIN T�VyED.6LRS GESIT` CLE 1 5 34
DAMAGE IIII._IIII HHttVVii((tt u
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE R 1
SHADE IN DAMAGED AREA 35
4 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 STATE FARM 167 t954-629-478
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Lemur YES[:]NO[:] CITATION# i o 80TTOM
15❑ sTnNowc s 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE PROPSnWNr YES NO �/ D:4259412846
16�
LAST NAME ROUGHLEY FIRST NAME JAMES MIDDLE W
INITIAL
17 F1 STREET ❑❑ 37 3509 SHATTUCK AVE S CITY RENTON ST, WA ZIP 980555725
NEW ADDRESS
18� IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED. 38
CDL INTERLOCKYES yo INTERLOCK YES No ves Na
19 DRIVERS STATE WA SEX M D.O.e. 07 29 1966 � 39
LICENSE# MMDdYY -
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSE C31337Y raTE WA vIN# 1C6JJTBG8ML586147 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2021 MAKE JEEP MODEL GLADIAT STYLE 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 INSURANCECO STATE FARM 1896571-D30.47B
IN EFFECT &POLICY# t STOP
V EILe ❑ ,J—I CITATION# CHARGE to BOTTOM
LEGnLLY YES N`.LJ
25 s ' s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG33060
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8332
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) ROUGHLEY KATHERINE E
ADDRESS&PHONE#
3509 SHATTUCK AVE S RENTON WA 980555725 SEXi F MMDooYBYYY 04 — 05 — 1971
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
z 2 POS. 'I 3 2 4 1 USE CLASS i 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 09-25-25 04:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
RAYMOND GORAJEWSKI 12399 913012025 2:06:45 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:15 PM TIME POLICE ARRIVED i 3:Y7 Pry
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG33060 CASE# 25-8332 DATE OF COLLI r�510NN + 09/25/25 15:12
L1
NARRATIVE
CC 25-8332
On 9/25/2025 at 1515 hours I was dispatched to a motor vehicle collision on a private way at around
the 485 block of Houser Way N in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was traveling South on the private way at the Kenworth/Paccar warehouse
while leaving work in the #1 lane.
Driver 1 stated that he was behind Unit 2 in the #1 lane of the Southbound private way proceeding
South.
Collision
Driver 2 stated that while driving and fluctuating speed due to speed bumps, Unit 1 approached from
behind and the front bumper of Unit 1 collided with the rear bumper of Unit 2.
Driver 1 stated that he was unaware of his speed and did not see that Unit 2 was slowing down.
Driver 1 stated that he did not have time to react and that the front bumper of Unit 1 collided with the
rear bumper of Unit 2.
Injuries
None reported.
Vehicle Disposition
Unit 1 was towed from the scene.
Proximate Cause
This collision occurred on private property. This case report is to document the incident.
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 15:56 on 9/25/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG33060 CASE# 25-8332 DATE AND TIME 09/25/2515:12
OF COLLISION
yx:,t
3 i e
l' 4
51ti l
V
�xw
yg:
I
t,
tp�d tl6 t i
! 9d
j
A
$}t
PAGE 4 OF 4