HomeMy WebLinkAbout25-7707 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EG36329 170
27
COLLISION REP FIT 1591971
CASE 25-7707 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 0923 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE PETROVITSKY RD
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 109THAVESE
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:9169406309 0 7 30
6� LAST NAME OGUTU FIRSTNAME JOSEPHINA MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 12107 SE 174TH LN APT U103 CITY RENTON ST WA 2jp, 980586279 z
NEW ADDRESS
]❑ 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 USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 ATE 14 CSF1773 STATE WA V N# 1 GKEK13RXVJ739110
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM ro
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 1997 CHEV TAHOE DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO JAHLEEL HARRIS 127.SE312TH STAPTF107 AUBURN WA 98032 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE CHARGE 5 36
EGHALLY YES❑NO❑ CITATION# 5A0625737 IMPROPER LANE USAGE o eorrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ DD 2067697159
16 a
LAST NAME KIRK FIRST NAME BRANDON MIDDLE I S
INITIAL
17❑ STREET ❑', 17600 134TH AVE SE APT D102 CITY RENTON ST WA ZIP 980586887 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NOF
19 DRIVER'S STATE WA SEX M D.C.B. O6 _ 12 _ 1978 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CNU5960 TATe WA vIN# 1GNFK13017R114303
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
I
VEH YEAR 2007 MAKE CHEV MODEL TAHOE STYLE DAMAGE TO WED NOO✓ BLIN TOWED BY Gov 44
jVEHl Yr
H YES NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO BRISTOL WEST G 01-3910221-03IN 1ULI�iKOTTlf0�—
EvE""LE CITATION# CHARGEYES N(�25 JOFFICER'S NAM (PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG36329
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7707
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) BOWSER BEYA B
(I.P.ST FIRST,
ADDRESS&PHONE#
17600 134TH AVE SE APT D102 RENTON WA 98058 SEXi F MMDOYyry 11 - OS - 2023
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 9 2 10 1 USE CLASS I1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
BEd MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT I 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.
C.ARNOLD 09-04-25 10:12 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1011012025 1:29:45 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 9:24 AM TIME POLICE ARRIVED',9:Y8 AM
PART I PAGE ❑OF 4❑
REPORT NO. EG36329 CASE# 25-7707 OF COLLISION
09/04/25 09:23
OF CbLLI510N
NARRATIVE
CC 25-7707
On 9/4/2025 at 0924 hours I was dispatched to a motor vehicle collision at the intersection of SE
Petrovitsky Rd and 109th Ave SE in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was facing East in the #2 lane of SE Petrovitsky Rd and was slowing to a stop
for a vehicle that was partially blocking the #2 lane trying to get into the 2-way center turn lane.
Driver 1 stated that she was in the #1 lane of SE Petrovitsky Rd proceeding East and was preparing
to merge from the #1 lane to the #2 lane.
Collision
Driver 2 stated that as he was stopped for traffic, the front bumper of Unit 1 collided with the rear
passenger side bumper of Unit 2.
Driver 1 stated that she began her lane change from the #1 lane to the #2 lane and did not see that
Unit 2 had stopped. Driver 1 stated that she was unable to react in time and the front bumper of Unit 1
collided with the rear bumper of Unit 2.
Injuries
None reported
Vehicle Disposition
Both vehicles were operational
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as
nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety.
Driver 1 was cited per RCW 46.61.140
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 10:08 on 9/4/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG36329 CASE# 25-7707 DATE AND TIME 09/04/25 09:23
OF COLLISION
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