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HomeMy WebLinkAbout25-8584 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 25-8584 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4900 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#TRIBAL OF 02 OBJECT 1 1 8 28 UNITS RESERVATION I STRUCK z 3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ cawsloN 10 - 1-- 2025 1723 17 ❑.❑ S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SE PETROVITSKY RD BLOCK NO. e✓ 10800 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e 0 4 29 MOTOR PEDAL- DAMAHRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El GE THRESHOLD D:2063765692 0 1 30 6 LAST NAME BEKALU FIRSTNAME NEBYU MIDDLE 1 1 2 31 INITIAL STREET ❑, 14012 SE 240TH PL CITY KENT ST I WA 2jp, 98042 z NEW ADDRESS ]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID -O B 06 — 08 — 2005 1 2 32 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑ 3 10 9❑ Pi aTES� CKG1123 sTArI WAvIN# JTDBCMFE7P3026002 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR 5 7 33 12 3 5 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T k GOVT.VEHICLE ] 3 34 13 4 2023 TOYT COROL 4D DAMAGE YES NOBS YES[:] ✓No REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO GEICO 4608343499 3 4 IN EFFECT &POLICY# 9TOP VE—LL 5 36 LEGALv res❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ : OWNFR ❑ YES 1/ NO D:6504229815 16 a LAST NAME CLOUTIER FIRST NAME STACY MIDDLE IR INITIAL 17❑ NEW STREETREs7 14251 SE 179TH PL CITY' RENTON ST WA ZIP 98058 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38 INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES t l NO❑ 19 LDIIVEW # STATE WA ]SEX IF M .C... 11 29 _ 1968 0 39 WELMET INJURY ] NATURE OF INJURIES 40 20 F1 ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 USE CLASS LEG PAIN ❑21❑ PLATE# CHT2333 TAre WA VIN# 41 SFRYD4H56H6026967 1 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. TOWED BY GOV HI 44 VEH YEAR 2017 MAKE /a C(fR MODEL MDX STYLE (/T DAMAGE TOWED NOO✓ BLIN YES NO 1/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE,IN DAMAGED AREA 4� 3 4 LIABILITY INSURANCE INSU&PORGY#E CO ALL STATE'966967143IN 1U 9TOP 5 VE""LE ❑ ,J� CITATION# CHARGE oBOTTOM LEGALLY YES N`L J 25 s 7 e 7TH NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26MAN 11462 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG37588 COLLISION REPORT III III III III III 111 1591972 CASE# 25-8584 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. J.THIELMAN 10-03-25 06:32 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1011412025 4:37:01 PM BADGE OR ID# 11462 OR]# WA0171300 TIME POLICE DISPATCHED! 5:24 PM TIME POLICE ARRIVED',5:37 PM PART PAGE IT]OF 4� REPORT NO. EG37588 CASE# 25-8584 FC LNaoy L isI©�ON O 10/03/25 17:23 F cu NARRATIVE During this incident, I was equipped with a body-worn camera, which records both audio and video. Portions of this incident were recorded. This report is merely a summary of the incident and is not intended to be an exact transcription of the entire investigation or what may have been captured with the recording system. I was operating an unmarked Tahoe B337 which was equipped with undercover emergency lights and sirens. Case Number 25-8584 On 10/03/2025 at approximately 1735 hours, I was dispatched to an unknown if injury collision in the 10800 block of SE Petrovitsky RD the City of Renton, King County, Washington. Dispatch relayed the call was generated by Toyota due to a crash notification. I arrived and located unit one WA/Lic CKG1123 driven by Nebyu Bekalu and unit two WA/Lic CHT2333 driven by Stacy Cloutier. Both units had airbags deployed and were inoperable. A tow was requested for unit one but unit two was able to drive into a nearby parking lot. Bekalu informed me of the following: He was exiting the parking lot at 10825 SE Petrovitsky RD intending to turn west on SE Petrovitsky. As he turned, he was struck by unit two on the front driver's side of his vehicle. Cloutier informed me of the following: She was traveling eastbound on SE Petrovitsky RD from 108th Ave SE in the curbside lane. Unit one began to turn west from the parking lot of 10825 SE Petrovitsky RD when she struck it, causing moderate damage to the front passenger side of her vehicle. Cloutier complained of leg pain but was ultimately not transported by RRFA. Given the statements by both drivers, 1 believe unit one to be the proximate cause of the collision due to him not granting the right of way to unit two. Both parties were given a business card with a case number. I certify (declare) under the penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed Sergeant J.Thielman/11462 10/03/2025 1824 hours Renton, WA. PAGE 3 OF 4 REPORT NO. EG37588 CASE# 25-8584 DATE AND TIME 10/03/2517:23 OF COLLISION } 3 $� � n � 3 au"Y, a l � 4 '1 �j yr. Fe iY c; „g r e � Q; tY pppppp or l a P� { n, PAGE 4 OF 4