HomeMy WebLinkAbout25-8889 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
SAS 25-8889 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 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 10 - 1-- 2025 1202 17 ❑-= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO.
1❑ e✓ ❑
MILEPOST
4a
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e AIRPORT WAY
0 5 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2067659449 0 4 30
6� LAST NAME ASEFA FIRSTNAME YARED MIDDLE G 1 2 31
INITIAL
STREET ❑ 16106 STONE AVE N CITY SHORELINE ST WA ZIP 981335746 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE CCL0840 STATE WA uN# 1HGCP26449AO49483
10 1❑ PI ATE�
TRAILER STATE TRAILE# STATE
11 3 5 PLATE# PLATE It FROM TO
rRLR. TRLR. 1 1 33
12 3 5 vIN#' VIN#
FROM TO
VEH.YEAR MAKE I MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
13 2009 HOND ACCOR DAMAGE YES�NO YES❑ NO✓ q 3 34
REGISTERED OWNER INFO GHEBREALIF HAILEMARIAM 16106 STONE AVE N SHORELINE WA 98133 SHADE IN DAMAGED A VEHICLE NO. 1 ❑
REA 35
14� LIABILITY INSURANCE INSURANCE CO STATE FARM 5479364-D23.47 3 4
IN EFFECT &POLICY# 9TOP
L-ALLe CHARGE 1 5 36
LE ALLY YES No CITATION# 5A0625793 PROHIBITED U TURN o eorrom
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2066976370
16 a
LAST NAME NAKASHIMA FIRST NAME BETTY MIDDLE M
INITIAL
17❑ STREET ❑', 6139 127TH PL SE CITY' BELLEVUE ST WA ZIP 980063972 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES
t l NO❑
19 D I`VE STATE WA ]SEX IF M D.O.B. 05 _ 24 1972 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CHP2785 TATE WA vIN1t 2HKRW2H57NH622073
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
%
'I
VEH YEAR 2022 MAKE HOND MODEL CR-I/ STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ERIC NAKASHIMA 6139127TH PL SE BELLEVUE WA 98006 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 584 6079-DO1-47IN IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
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. EG38126
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8889
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 10-14-25 12:49 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
10/18/2025 7:22:52 AM
RAYMOND GORAJEWSKI 12399
BADGE OR ID# 12509 OR]4$ WA0171300 TIME POLICE DISPATCHED; 12:05 PM TIME POLICE ARRIVED',12:12 PM
PART I PAGE IT]OF 4�
REPORT NO. EG38126 CASE# 25_8889 O COLLOTINIE
OFF CbLLI510N 10/14/25 12:02
NARRATIVE
CC 25-8889
On 10/14/2025 at 1205 hours I was dispatched to a motor vehicle collision at the intersection of
Rainier Ave N and Airport Way in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was in the #3 lane of Southbound Rainier Ave N preparing to perform a
lefthand turn to proceed East on Airport Way
Driver 1 stated that he was in the #3 lane as well and was preparing to perform a U-turn to proceed
back North on Rainier Ave N from Airport Way.
Collision
Driver 2 stated that Unit 1 was to the right of her in lane #2 and as the light turned green, Unit 1
performed a U-turn in front of her. Driver 2 stated that she did not have time to react as she was
already making her lefthand turn and the front passenger side bumper of Unit 2 collided with the rear
drivers side door of Unit 1.
Driver 1 was adamant that he was in lane #3 and when I told him that based upon the damage
present that would have been impossible, Driver 1 refused to provide further information. Driver 1
only said that Unit 2 struck the rear drivers side door of his vehicle.
It should be noted that there is a traffic control device that specifies that vehicles in the #3 and #2
lanes are required to turn left only.
It should be noted that this area is under construction and traffic revision and that the #3 lane is the
leftmost lane of Southbound travel.
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 any vehicle
shall not turn such vehicle so as to proceed in the opposite direction unless such movement can be
made in safety and without interfering with other traffic.
Driver 1 was cited per RCW 46.61.295.
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 12:38 on 10/14/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG38126 CASE# ' 25-8889 DATE AND TIME 10/14/25 12:02
OF COLLISION
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