HomeMy WebLinkAbout25-9015 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-9015 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 28
2 0
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
CowsloN 10 - 18 - 2025 0950 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S GRADY WAY BLOCK NO. e✓ ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BENSON RD S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2064765567 0 51
30
6� LAST NAME STANFORD FIRSTNAME JYL MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 13108 160TH AVE SE CITY RENTON ST WA 21p 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 1 CLASS NATURE OF INJURIES z❑
3
10❑ P1 ATNES# D47851 H sTAr WAu N# 5TFDZ56NOMX060225
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. $ 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ $ 34
13 ZO21 TOYT TACOM TR DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO 111STANFORD 13108160THAVE SE RENTON WA 98059 D:2064765567 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO FARMERS 548824699 3 4
IN EFFECT &POLICY# 9TOP
VErIICLE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4259229831
16 a
LAST NAME GANNAWAY FIRST NAME NORMA MIDDLE R
INITIAL
17❑ STREET NEW ADOREss❑' 16613 ISSAQUAH HOBART RD SE CITY ISSAQUAH ST WA ZIP 98027 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑No� INTERLOCK ves No� YEs NDF
19 DRIVER'S STATE WA ]SEX IF D.C... 07 O6 _ 1968 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# D886796 TArE 41
WA VIN1i 1FDBF6ZG3PKA13281 1
42
22❑ PILER LATE# STATE PLATE# STATE
T
23❑ VIN 43
IN##. IN RLR
' #.
VEH YEAR 2023 MAKE FORD MODEL TRANSIT STYLE CG VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO THE HOME DEPOT 325120TH AVE NE BELLEVUE WA 98005 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 964733112IN 1 9TOP
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
RAYMOND WATSON 13127 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG40686
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9015
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.
RAYMOND WATSON 10-18-25 11:37 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1012312025 9:05:03 AM
BADGE OR ID# 13127 OR]# WA0171300 TIME POLICE DISPATCHED 9:51 AM TIME POLICE ARRIVED',9:54 AM
PART I PAGE IT]OF 4�
REPORT NO. EG40686 CASE# 25-9015 OF COLLISION
10/18/25 09:50
OF CbLLI510N
NARRATIVE
25-9015
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized.
On 10/18/2025 at approximately 0951 hours, myself, Officer R. Watson, was dispatched to a non-
blocking accident, at the intersection of S Grady Way and Wells AVE S, within the City Limits of
Renton, County of King, State of Washington.
Dispatch notes stated that there were two vehicles involved, no injuries, non-blocking and significant
damage.
When I arrived on scene, I observed two vehicle both pulled on the side of the road on Wells AVE S
and both parties were speaking outside of the vehicles.
Unit#1 driven by Jyl N. Stanford (DOB 06/28/1988) verified by WA DOL photo, stated she as driving
a White 2021 Toyota Tacoma, WA plate #D47851 H. There were no other occupants in the vehicle.
Jyl state she was traveling north bound on S Grady Way and when she approached the intersection
Benson RD S, unit#2 came to a stop and started to conduct a U-turn. When unit#2 stopped to make
the U-turn, Jyl stated she collided with the rear of unit#2. Jyl stated that she had no injuries and
declined aid. When I asked for Jyl's license, registration and insurance she was able to provide all
documentation. Unit#1 had moderate front end damage. Unit#1 was able to be driven from the
scene and had no airbag deployment.
Unit#2 driven by Norma R. Gannaway (DOB 07/06/1968) verified by WA DOL photo, stated she was
driving a White 2023 Ford Transit, WA plate #D88679B, owned by Home Depot. There was another
occupant in the vehicle, but he did not identify himself. Norma stated she was attempting a U-turn
when she saw unit#1 coming towards her at a high rate of speed and then collided with the rear of
her vehicle. Norma said that he had no injuries and declined aid. When I asked for Norma's license,
registration and insurance she was able to provide all documentation. Unit#2 had slight rear end
damage. Unit#2 was able to be driven from the scene and had no airbag deployment.
An exchange of information was completed and provided to each party. Pictures were taken of each
vehicle and uploaded to evidence.com.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer R. Watson #13127 10/18/2025 1133 hours, Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EG40686 CASE# 25-9015 DATE AND TIME 10/18/25 09:50
OF COLLISION
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