HomeMy WebLinkAbout25-8090 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
SAS 25-8090 2
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 09 - 1-- 2025 0837 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
DUVALL AVE NE
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e NE 4TH ST
0 4 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:4252137298 0 4 30
6� LAST NAME COVACI FIRSTNAME MIRELA MIDDLE L 1 1 2 31
INITIAL
STREET ❑1 1710 SHELTON AVE NE CITY RENTON ST WA 2jp, 980563358 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
LRIIVER # STATE WA SEX'F MM D Y' 07
8❑ — 26 — 1962 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10❑ PI ATE AFC6353 sTATI WAurN#' 1J4G148KX4W321222
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FR.. ro
TRLR. A'RLA2 1 3 33
12 3 5 VIN#' VIN#'
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 3 34
13 4 2004 JEEP LIBERT DAMAGE YES NO YES NO✓
REGISTERED OWNER INFO DAN COVACI 1711SHELTON AVE NE RENTON WA 98056 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14� LIABILITY INSURANCE INSURANCECOAMERICAN FAMILY INSURANCE 41027-06949.84 3 4
IN EFFECT &POLICY# 9TOP
VE—LE CHARGE 5 36
LECALLv YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/ NO D:2066730895
16 a
LAST NAME TELLEZ URENA FIRST NAME OSCAR MIDDLE I C
INITIAL
17❑ STREET ❑', 4822 NE 9TH ST CITY RENTON ST WA ZIP 980594688 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.O.B. 08 _ 24 1985 El
39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE D18037E TATE WA VIN# 2NPNHM6X5AM109044
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2010 MAKE PTRg MODEL 330 STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO THE AMIGOS DELIVERY SERVICE 4822 NE 9TH ST RENTON WA 98059 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO PIONEER SPECIALTY INSURANCE CO CPP 1374383 1 9TOP 5
IN EFFECT
vE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG36333
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8090
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 09-17-25 11:30 AM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1011012025 1:43:45 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 8:40 AM TIME POLICE ARRIVED',8:44 AM
PART I PAGE IT]OF 4�
REPORT NO. EG36333 CASE# 25-8090 OF COLLISION
09/17/25 08:37
OF CbLLI510N
NARRATIVE
CC 25-8090
On 9/17/2025 at 0840 hours I was dispatched to a motor vehicle collision at the intersection of Duvall
Ave NE and NE 4th St in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that he was on Duvall Ave NE at the intersection of NE 4th St facing South preparing
to perform a lefthand turn from the #2 lane.
Driver 1 stated that she was on Duvall Ave NE at the intersection of NE 4th St facing South preparing
to perform a lefthand turn from the #3 lane.
Collision
Driver 2 stated that when the light turned green that he began his lefthand turn and while in the
intersection, the front passenger side bumper of Unit 1 collided with the drivers side middle portion of
Unit 2, striking the toolbox on that side.
Driver 1 stated that she began her lefthand turn and she was adamant that she was within her lane.
Driver 1 initially stated that the sun was in her eyes at the time of collision. Driver 1 stated originally
that Unit 2 performed a wide turn and then changed her story later to say that Unit 2 performed a
narrow turn from the #2 lane. Driver 1 stated that the front drivers side bumper of Unit 1 collided with
the passenger side middle portion of Unit 2, striking the toolboxes on that side.
Injuries
None reported.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I was unable to locate any traffic cameras at the intersection and am unable to determine proximate
cause at this time.
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 11:21 on 9/17/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG36333 CASE# 25-8090 DATE AND TIME 09/17/25 08:37
OF COLLISION
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PAGE 4 OF 4