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COLLISION REP FIT 1591971
CASE 25-8027 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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# ❑
cawsloN 09 - 1-- 2025 1340 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SW GRADY WAY BLOCK NO. e✓ 1107
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 1 $ 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2067470035 1 9 30
6� LAST NAME DOAN FIRSTNAME NGOC-BICH MIDDLE 1 2 31
INITIAL
STREET ❑, 4645 S AUSTIN ST CITY SEATTLE ST WA 2jp, 981183923 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
LICENSE CSZ6513 sTAr1 WAVIN# JTDJTUD36CD531899
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 0 0 33
12 0 0 VIN#' VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 $ 34
13 A 2012 TOYT YARIS DAMAGE YES NO YES[:] NO✓
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� UABILI INSURANCEn INSURANCE CO STATE FARM 4690905-E04.47D 2 3
IN EFFECT &POLICY# 9TOP
VE— CHARGE 1 5 36
LEGALLv YFS❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:2062916320
16 a
LAST NAME COLEMAN FIRST NAME SHALYNN MIDDLE I R
INITIAL
17❑ STREET ❑', 1649 INDEX AVE SE CITY RENTON ST WA ZIP 980583821 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 LICENSE# STATE I WA SEX F MMDDW 09 _ 15 _ 1988 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BQD9137 TAre WA VINE 3KPFN4A89JE176836
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 201E MAKE I(1/� MODEL FORTE STYLE DAMAGE TOWED NOO✓ BLIN TOWED BY ovHyES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAGED AREA
2 4
LIABILITY
INSURANCE INSU&PORGY#E CO PROGRESSIVE 938990352IN IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s 7 e
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 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG36335
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8027
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
PM 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 09-15-25 02:12 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1011012025 1:42:25 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED; 1:42 Pry] TIME POLICE ARRIVED',1:44 PM
PART I PAGE IT]OF 4�
REPORT NO. EG36335 CASE# 25-8027 OF COLLISION
09/15/25 13:40
OF CbLLI510N
NARRATIVE
CC 25-8027
On 9/15/2025 at 1342 hours I was dispatched to a motor vehicle collision at 1107 SW Grady Way at
the Global Credit Union in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was in the parking lot preparing to pull into a handicap parking space facing
South on the North side of the building.
Driver 1 stated that she was facing North in a parking stall and was preparing to reverse into the
travel lane.
Collision
Driver 2 stated that as she was pulling into the parking stall, Unit 1 reversed and turned into her,
causing the rear passenger side bumper of Unit 1 to collide with the rear passenger side door of Unit
2.
Driver 1 stated that she began to reverse and did not see Unit 1 behind her. Driver 1 stated that the
rear passenger side bumper of Unit 1 collided with the rear passenger side door of Unit 2.
Injuries
None reported.
Vehicle Disposition
Both vehicles were operational.
Final Disposition
Although this collision occurred on private property, a report was drawn due to the amount of damage
that was caused.
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 14:06 on 9/15/2025 in the City of Renton, King
County, Washington.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 2
Action Code: PARKING IN PARKING STALL
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EG36335 CASE# ' 25-8027 DATE AND TIME 09/15/25 13:40
OF COLLISION
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PAGE 4 OF 4