HomeMy WebLinkAbout25-9215 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG44827OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-9215 2
RESULTED STOLENSTATE 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#
eaCL s on' 10 - 24 - 2025 1438 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 43RD ST BLOCK NO. e 400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e ON NB SR 167
2 0 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO 0 1 30
6 LAST NAME SANCHEZ FARIAS FIRST NAME LUCIO MIDDLE N 1 1 2 31
INITIAL
STREET ❑) 9409 27TH AVE SW APT D CITY, SEATTLE ST WA ZIP; 981263994 2
'.NEW ADDRESS '
7 +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYES NO INTERLOCKYEs N YES F No
DRIVERS# STATE WA SEX M MMD4YY' 12 — 12 — 1957 t 1 2 32
8❑
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET INJURY 7 NATURE of INJURIES 2
USE CLASS L SHOULDER
10 al ENSrtEI BCB8605 srATE WA VIN#, 2TIBURHE8GC744690 3
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR rRLR 7 3 33
12 3 5 VIN# vIN#
FROM TO
VERYEAR 2016 MAKE TOy. MODEL COROL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 3 34
13� DAMAGE YES II_II NO `/ YESII_I) NO
REGISTERED OWNER INFO LUCID SANCHEZ FARIAS 1202 N PEARL STAPT 204 TACOMA WA 98406 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# 9TOP
VEnicLE CHARGE t 5 36
Lec LY YES❑NO❑ CITATION# t a 80TFOM
15❑ STM ING s 7 e
11
UN# MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 VEHICLE CYCLE nWNFR YES NO �/
16�
LAST NAME CONKLIN FIRST NAME DUSTIN MIDDLE' W
INITIAL
17 STREET ❑ 37
11809 SE 218TH PL CITY KENT ST, WA ZIP 980312365
NEW ADDRESS I I I I 1
❑
18❑ CDL IGNITION REQUIRED CGN[TION PRESENT MEDICAL TRANSPORTED: ❑ 38
INTERLOCKYEs N4 NTERLOCK YES No YEs Nd
19 DRIVER'S' STATE WA SEXI M D.O.B. 03 24 1982 � 39
LICENSE# MMDdYY —
HELMET INJURY: NATURE OF INJURIES 40
20❑ ON DUTY� STATUS A[RBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 PLATE# D79635E rare WA vIN# 1GCHC33J1VF001601 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 1997 MAKE CHEV MODEL GMT-400 STYLE VEHICLE TOWED TO --- TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO DUSTIN CONKLIN 11809 SE 218TH PL KENT WA 98031 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# t STOP
vewaE ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGnttY YES NIL]
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-189(R 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG44827
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9215
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
POS. 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.
M.LEVERTON 10-24-25 03:28 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 111412025 10:28:42 AM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 1 2:38 PM TIME POLICE ARRIVED i 2:40 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG44827 CASE# 25-9215 DATE OF COLLI r�510NN + 10/24/25 14:38
L1
NARRATIVE
blu/1 merge tl to nb 167 into lane two into side of wht/2
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at about the 400
block of S 43rd St.
When I arrived both vehicles were blocking both lanes of EB S 43rd St.
I contacted the driver of unit 1 who told me in Spanish he did not speak English, Spanish only. I
asked him to wait a minute. I asked him if he was hurt in Spanish and he told me no. I asked unit 2 if
he was hurt and he told me no. I had both vehicles move to the next closest roadway and off the
road.
I contacted the driver of unit 2 who told me he was eastbound lane 2 on his green light. He told me
that unit 1 was positioned several cars back on a red light in the left turn lane for NB SR 167. Unit 2
said unit 1 made a sudden lane change, and unit 2 slammed on his brakes and make contact with
unit 1. He did not require a tow for damages.
I used Google translator to ask Unit 1 if he made a lane change and told me no that they just crashed.
He did not provide any additional information. He complained about left shoulder and back pain. He
was treated and released on scene by Renton Fire.
Both drivers received info exchange copies. I used GT to explain to unit 1 what to provide to his
insurance company for making a claim.
Information/insurance only.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 10-24-2025
PAGE 3 OF 4
REPORT NO. EG44827 CASE# 25-9215 DATE AND TIME 10/24/25 14:38
OF COLLISION
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