HomeMy WebLinkAbout25-7741 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EG36320 170
27
COLLISION REP FIT 1591971
CASE 25-7741 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 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# ❑
cowsloN 09 - 1-- 2025 1102 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW 43RD ST BLOCK NO. e✓ 400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 10 00 FEET MILES ❑ S ❑ W e DAMS AVE S
0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2067796510 0 11
30
6� LAST NAME SERRANO FIRSTNAME CINDY MIDDLE F 1 1 2 31
INITIAL
STREET El 420 SW 154TH ST APT 107 CITY BURIEN ST WA ZIP 981662233 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ DRIVERS
# STATE WA SEX'F MIDI Y' 10 — 30 — 1986 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES z❑
❑10 9❑ P1 ATNES# CEA2514 sTAr WWAvN# JN16J1CROKW621005 3
5 TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR. 1 7 33
12 2 5 VIN#' VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 3 2019 NISS ROGUE DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO CIND1SERRAN01441225THAVE S SEATAC WA 98168 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAFECO H2520959 3 4
IN EFFECT &POLICY# 9TOP
VEwcLe CHARGE 1 5 36
LEGALLY YES No CITATION# 5A0723013 FAIL YIELD PRIVATE RD MOTOR o aorrom
15❑ NDING 6
MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:3605291000
VEHICLE CYCLE OWNER YES�/ NO
16 a
LAST NAME GUTHOLM FIRST NAME JAMES MIDDLE I D
INITIAL
17❑ STREET ❑', 306 Z ST SE CITY' TUMWATER ST WA ZIP 985015555 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs❑NOF YEs❑NOF,/
19 D IVEW # STATE WA SEX M M D.C.B. 01 21 1966 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE AZN0858 TAre WA vIN# KMHGN4JE6FU099891
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2015 MAKE HYUN MODEL GENESIS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JAMES GUTHOLM 306 Z ST SE TUMWATER WA 98501 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 904624454IN IGQI
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
D.NELSON 12421 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG36320
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7741
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GUTHOLM K/MBERLYL
(I.P.ST FIRST,
ADDRESS&PHONE# D O.B. '
306 Z ST SE TUMWA TER WA 985015555 3605291000 SEXi F MMDOYyry 01 - 14 - 1972
PASSENGER WITNESS UNIT# 2 PEATas 2 CLASS
3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES
USE ' 11
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX' MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
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.
D.NELSON 09-05-25 04:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1011012025 1:31:28 PM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED! 11:22 AM TIME POLICE ARRIVED',11:22 AM
PART I PAGE IT]OF 4�
REPORT NO. EG36320 CASE# 25-7741 OF COLLISION
09/05/25 11:02
OF CbLLI510N
NARRATIVE
25-7741 ACC
On 9/5/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a two-vehicle non injury collision near the 400 block of
SW 43rd St. The involved caller reported that both vehicles had pulled off the roadway.
I arrived on scene and confirmed there was no injury to either party.
The driver of the 2019 Nissan Rogue WA/CEA2514, was identified by her WADL as Cindy F Serrano
DOB: 10/30/1986. Cindy said that she was pulling out of the VMC parking to travel west on S 43rd St.
She said that as she began to enter the #1 lane, she was struck by Unit 2. No airbags had deployed
and there was damage to the driver side front bumper/quarter panel are of the Nissan.
The driver of the 2015 Hyundai Genesis WA/AZN0858, was identified by his WADL as James D
Guthom DOB: 1/21/1966. James said that he was travelling west in the #1 lane of SW 43rd St when
the Nissan pulled out of the parking lot in front of him. No airbags were deployed inside the Hyundai
and there was damage to the passenger side front quarter panel/bumper.
The exit from the VMC center parking lot is a right turn only with a stop sign.
Both vehicles were drivable, and no tows were required.
I completed a Sector citation for RCW 46.61.205 Failure to Yield Private Way Motor Vehicle under
Sector citation #5A0723013 for Cindy. This citation should be mailed to her DOL address.
RCW 46.61.205 states "(1) The driver of a vehicle about to enter or cross a highway from a private
road or driveway shall yield the right-of-way to all vehicles lawfully approaching on said highway."
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 9/5/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG36320 CASE# ' 25-7741 DATE AND TIME 09/05/25 11:02
OF COLLISION
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