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HomeMy WebLinkAbout25-9536 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 25-9536 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AGENC 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2❑ TRIBAL 02 TOTAL#OF 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 11 - 1-- 2025 1309 17 ❑.= S IN 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ 108TH AVE SE BLOCK NO. e✓ --- ----� ❑ 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ ❑ FEET e S ❑ W e SE CARR RD 0 5 29 MOTOR ✓ PEDAL- DAMAGE THRESHOLD MET PHONE NIT 01 VEHICLE ❑ CYCLE. ❑ YES NO F D:9379867304 0 1 30 6 LAST NAME HENDERSON FIRSTNAME FAITH MIDDLE J 1 1 2 31 INITIAL STREET ❑ 105 N EXCELSIOR AVE RM 5 CITY BUTTE ST MT 2jp, 597010000 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO 8❑ LDRIVER # STATE MT SEX'F MID .O B 04 - 28 - 1997 1 2 32 9❑ ON DUTY❑ STATUS' AIRBAG 4 RESTR 4 EJECT 1 1 INJURY —, [NATURE OF INJURIES H U SE CLASS 7 LEFT SHOULDER PAW z❑ 3 10❑ PIATNFS# CGW9768 sTAT WAuN# W1N4N4HB5PJ508381 5 TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM TO TRLR. TRLR. 1 1 33 12 3 5 VIN#' VIN# FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GES[VEHICLE 5 1 34 13 3 2023 MERZ GLA DAMAGE YES 0NO f �AWkkRS vEs❑ No REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 r1 14 LIABILIT INSURANCE INSURANCE CO GEICO 6204.37.97.02 3 IN EFFECT &POLICY# 9TOP V-CLE CHARGE 5 36 LEGALLY YES NO CITATION# 5A0909588 PROHIBITED U TURN o aorrom 15❑ STANDING 8 7 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2534574428 16 a LAST NAME STEMPNIAK FIRST NAME BLAKE MIDDLE G INITIAL 17❑ STREET ❑', 23821 124TH AVE SE CITY KENT ST WA ZIP 980313609 37 NEW ADDRESS ❑ 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38 INTERLOCK YEs❑NOR INTERLOCK v�Esl I I NOF YES t l NO❑ 19 DRIVERS # STATE WA SEX M Mr D.C.B. 01 19 _ 2006 39 WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE I CSC3224 TATe WA VIN# 1HGCV1F1XLA041952 ❑ 41 pLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ VIN#. 43 TRLR RLR 'IN#. GI VEH YEAR 2020 MAKE HOND MODEL ACCORD STYLE jVEHl DAMAGE TO WED NOO✓ BLIN TOWED By 44 Yr OV H YES NO 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE &POINSURGY#E CO STATE FARM 0613620-AO1-47FIN CgVE""LE ❑ ,J� CITATION# CHARGE i o LEGALLY YES N`L J 25 s 7 6 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. EG44869 COLLISION REPORT III III III III III 111 1591972 CASE# 25-9536 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 11-03-25 02:25 PM NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 111412025 11:51:51 AM BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED 1:11 PM TIME POLICE ARRIVED',1:20 PM PART B PAGE IT]OF 4� REPORT NO. EG44869 CASE# 25-9536 F LNa O 11/03/25 13:09 F coy�isI©�ON u NARRATIVE CC 25-9536 On 11/3/2025 at 1309 hours I was dispatched to a motor vehicle collision at 108th Ave SE and SE Carr Rd in the City of Renton, King County, Washington. Pre-Collision Driver 2 stated that he was traveling North on 108th Ave SE approaching SE Carr Rd in the #2 lane. Driver 1 stated that she was facing South on 108th Ave SE and began to perform a u-turn to proceed North on 108th Ave SE. Collision Driver 2 stated that Unit 1 performed the u-turn suddenly and that he was unable to stop in time to avoid a collision. Driver 2 stated that the front bumper of Unit 2 collided with the rear passenger side wheel of Unit 1. Driver 1 stated that she began her u-turn and the front bumper of Unit 2 collided with the rear passenger side wheel of Unit 1. Injuries Driver 1 reported left shoulder pain but refused medical at the scene. Vehicle Disposition Unit 1 was towed from the scene. 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 13:55 on 11/3/2025 in the City of Renton, King County, Washington. PAGE 3 OF 4 REPORT NO. EG44869 CASE#', 25-9536 DATE AND TIME 11/03/25 13:09 OF COLLISION H AVE, t „ i s t (w s o- t k t t � t t,, t z � ti p. v4 1, tt Y Ft �tY B p PAGE 4 OF 4