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HomeMy WebLinkAbout25-8990 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG41009oc� RA COLLISION REPORT 1591971 INTERSTATE CITY STREET FIRE I CASE# 25-8990 2 RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCAI-A`NG 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 02 STRUCK RESERVATION : 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eOCL s on' 10 - 17 - 2025 1452 17 =.= S 8 W e OF IN e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ SGRADYWAY BLOCK NO. e 700 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 100 00 FEET e✓ S 8 W e✓ TALBOT RD S 2 0 29 MOTOR PEDAL- DAMAG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YES No �/ D:2064465055 0 1 30 5 LAST NAME ROSALES FIRST NAME VERNA MIDDLE M 1 2 31 INITIAL STREET ❑ 20305 90TH PL S CITY; KENT ST I WA ZIP; 980311729 2 NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEflIGAL TRANSPORTED' 3 INTERLOCKYEs NO✓ INTERLOCKYEs N©✓ YES NOW 8 DRIVER # STATE WA SEXI F MMDDYY' 08 - 18 - 1970 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 CLASSY 1 [NATURE of INJURIES 2 LICENSE, CDJ2382 STATE WA VIN# 7SAYGDEE6NF355230 3 10 Fq I as ATP tt TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# ROM To TRLR TRLR 7 1 3 33 12 3 5 VIN# vIN# FROM TO VEH.YEAR 2022 MAKE TESL MODEL MODEL STYLE SD VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34 13� DAMAGE YES II_II NO ✓ YESII_I) NO REGISTERED OWNER INFO ANGELO ABELA 20707 SE 162ND WAY RENTON WA 98059 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 $ INSURANCE CO 3 4 14 IN EFFTYINSURANCE� STATE FARM 4fi72738 E0247C IN EFFECT &POLICY# i 9TOP 5 vEn ' CHARGE to 80TTOM 36 1ALLY 5 srn yes❑NO❑ CITATION# 5A0882618 FLD SIGNAL STOPS/TURNS-UNSAFE s 7 e DING MOTCYR ✓ PEDAL- PEDESTRIAN1:1 PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES NO �/ D:4257936351 16� LAST NAME BROCK FIRST NAME DOUGLAS MIDDLE' A INITIAL 17 F1 STREET ❑❑ 37 17306 119TH LN SE APT M1 CITY RENTON ST, WA ZIP 980586041 NEW ADDRESS 1 g IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 38 CDL INTERLOCKYEs No✓ INTERLOCK YESEl NOF,-/Il ves No 19 DRIVER'S STATE WA SEXI M I D.O.B. 06 05 1971 � 39 LICENSE# MMDDYY — HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY� STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑ 21 LICENSE BPP2035 raTE WA vIN# 1FMCU9HD4KUA55491 41 22❑ STATE PLAAILER TE# STATE 42 PLATE# 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2019 MAKE FORD MODEL ESCAPE STYLE $D VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ VES NO✓ REGISTERED OWNER INFO DOUGLAS BROCK 17306119TH LN SE APT MI RENTONWA98058 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO ALLSTATE 976 241 315 IN EFFECT &POLICY# tUV Q emae ❑ , CITATION# CHARGE LEGn�LY YES N`[ 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 D.NELSON 12421 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG41009 COLLISION REPORT III III III III III 111 1591972 CASE# 25-8990 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES PC& I 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. D.NELSON 10-17-25 04:05 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 1012412025 7:39:04 AM BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:53 PM TIME POLICE ARRIVED i 2:55 PM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4 REPORT NO. EG41009 CASE# 25-8990 DATE OF COLLI r�510NN + 10/17/25 14:52 L1 NARRATIVE 25-8990 ACCBLK On 10/17/2025 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the City of Renton. I was dispatched to a report of a two-vehicle, blocking collision with no injury near the intersection of S Grady Way and Talbot Rd S Renton/King/WA. I located both vehicles stopped in the #1 lane of eastbound S Grady Way, I confirmed there was no injury, and both vehicles were able to move out of the roadway. The driver of the 2022 Tesla Model Y WA/CDJ2382 (Unit 1) was identified by her WADL as Verna M Rosales DOB: 8/18/1970. Verna said that she was in the #2 eastbound lane and needed to be in the #1 lane which is a right turn only lane onto Talbot Rd S. Verna said that she turned her turn signal on and then began to move over when she struck Unit 2. There was minor damage to the passenger side front wheel and wheel well. There was no airbag deployment in the Tesla. The driver of the 2019 Ford Escape WA/BPP2035 (Unit 2) was identified by his WADL as Douglas A Brock DOB: 6/5/1971. Douglas said that he was driving east in the #1 lane when the Tesla made a lane change from the #2 lane and struck him, he said that he did not have anytime to move out of the way. There was minor damage to the front driver side wheel and wheel well of the Ford. There was no airbag deployment in the Ford. Both vehicles were drivable. cited Verna for Unsafe Lane Change RCW 46.61.305 under Sector citation #5A0882618. This citation should be mailed to Verna's DOL address. RCW 46.61.305 states: (1) No person shall turn a vehicle or move right or left upon a roadway unless and until such movement can be made with reasonable safety nor without giving an appropriate signal in the manner hereinafter provided. Nothing further. I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. D. Nelson #191 10/17/2025 Renton WA PAGE 3 OF 4 REPORT NO. EG41009 CASE# 25-8990 DATE AND TIME 10/17/2514:52 OF COLLISION k ) c 4 i�lkkg ,}} l; i k y � r k kk c x' w , V,Y 3 Y Y R x i� 4 k y PAGE 4 OF 4