HomeMy WebLinkAbout25-7919 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-7919 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION'. 09 — 11 — 2025 0908 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e SE CARR RD
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2066319671 0 81
30
6� LAST NAME ALLEN FIRSTNAME COREY MIDDLE D 1 2 31
INITIAL
STREET ❑ 1410E 64TH ST CITY TACOMA ST WA ZIP 984043432 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ PI ATE CJT2527 sTArI WAvIN#' 1 HGCY1 F35PA025589
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 0 0 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE J 9 34
13 3 2023 HOND ACCOR DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP
vEH .e la CHARGE 10 BOTTOM 5 36
YES No CITATION# 5A0625751,5A0625751 FOLLOW VEHICLE TOO CLOSELY,OP
15❑ STANDING 8 7 6
MOTOR PEDAL PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ D:5716853157
VEHICLE CYCLE '. OWNER YES NO 1/
16 a
LAST NAME MEHARI FIRST NAME AWOT MIDDLE G
INITIAL
17❑ STREET ❑', 17932 110TH PL SE CITY' RENTON ST WA ZIP 980556562 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCK YEs❑NOR INTERLOCK YEs I I No� YES t l No❑
19 D IVEW #
I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I CKF4784 TAre WA VIN1i 3N1CP5BV1LL553832
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
GI
VEH YEAR 2020 MAKE jyl$S MODEL KICKS STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&POLICY#E CO GEICO 61427251IN 1 GD
LEGAL25
LY YES N�
❑ s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG36327
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7919
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
C.ARNOLD 09-11-25 11:13 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1011012025 1:41:47 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 9:92 AM TIME POLICE ARRIVED',9:24 AM
PART I PAGE IT]OF 4�
REPORT NO. EG36327 CASE# 25-7919 OF COLLISION
09/11/25 09:08
OF CbLLI510N
NARRATIVE
CC 25-7919
On 9/11/2025 at 0912 hours I was dispatched to a motor vehicle collision at the intersection of 108th
Ave SE and SE Carr Rd in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was stopped for a red light in the #3 lane of 108th Ave SE at SE Carr Rd
facing North.
Driver 1 stated that he was behind Unit 2 in the #3 lane of Northbound 108t Ave SE at SE Carr Rd.
Collision
Driver 2 stated that while stopped, the front bumper of Unit 1 collided with the rear bumper of Unit 2.
Driver 1 stated that he must have fallen asleep or something and was unable to brake in time. Driver
1 stated that the front bumper of Unit 1 collided with the rear bumper of Unit 2.
Driver 1 was unable to provide me with valid insurance. I called Progressive for him and was told that
his policy had lapsed in April of this year and he was not covered.
Injuries
None reported
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because the driver of a motor
vehicle shall not follow another vehicle more closely than is reasonable and prudent, having due
regard for the speed of such vehicles and the traffic upon and the condition of the highway.
Driver 1 was cited per RCW 46.61.145 and RCW 46.30.020.
1 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 11:09 on 9/11/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG36327 CASE# 25-7919 DATE AND TIME 09/11/25 09:08
OF COLLISION
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PAGE 4 OF 4