HomeMy WebLinkAbout25-8897 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 25-8897 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENC 4100 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#
cawsloN 10 - 1-- 2025 1520 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE SUNSET BLVD BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �,❑ FEET e S ❑ W e EDMONDS AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO F,/ I D:2064371918 30
6� LAST NAME STURDIVANT FIRSTNAME CELINA MIDDLE C 1 1 2 31
INITIAL
STREET ❑1 18936 178TH PL SE CITY RENTON ST WA Zlp' 980580326 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/iNTERLOCKYEs NO INTERLOCKYEs Z/NO YES �No /
LRIIVER # STATE WA SEX'F M .O B 05
$❑ — 02 — 1982 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CPR2333 sTATe WAvIN# 5FNYG1H97SB040507
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12❑ VIN#j VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE $ 34
13 3 202$ HOND PILOT SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO JOSEPH STURDIVANT 18936178TH PL SE RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 1076876E2247F 3 4
IN EFFECT &POLICY# 9TOP
VEHICLe 5 36
LEGALLY
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN ✓ PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE ❑ CYCLE ❑ ❑ OWNER
❑ YES 1/ NO D:4253068346
16 a
LAST NAME PHANG FIRST NAME MATTHEW MIDDLE H
INITIAL
17❑ STREET ❑', 671 EDMONDS AVE NE CITY' RENTON ST WA ZIP 980563673 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 LICENSE# STATE WA SEX M MMDDW 10 _ 23 _ 2006 39
20 ON DUTY STATUS 4 AIRBAG RESTR EJECT I WEB MEET 2 LASSY 6 SCRAPES AND NATURE OF BRUISES INJURIES 40
BRUISES TO LEFT LEG AND HAND ❑
❑21❑ TATE 41
LICENSE 'l
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 1 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
vE"'LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
=ON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12421 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG41005
COLLISION REPORT III III III III III 111
1591972 CASE# 25-8897
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HALFON DAVID
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1310 MONTEREY AVE NE RENTON WA 98056 4256531222 SEX M MMDDYyvv 05 - 07 - 1956
PASSENGER WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑ �, POS. I USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL) ZOOK DAVID C
ADDRESS&PHONE# D O B
16220 NE 2 ST BELLEVUE WA 98008 4253060761 SEX' M MMDDvvvv27 _ 1963
PASSENGER ❑ POS. USE CLASS WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
NAME
(LAST FIRST,MIDDLE INITIAL) HUBBEL ACE J
ADDRESS&PHONE# 972 EDMONDS AVE NE,UNIT B RENTON WA 98056 4256151914 SEX MM 19 _ 2008
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY 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.
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 7:38:19 AM
BADGE OR ID# 12421 ORI# WA0171300 TIME POLICE DISPATCHED 3:21 PM TIME POLICE ARRIVED',3:22 PM
PART I PAGE IT]OF 4�
REPORT NO. EG41005 CASE# 25_8897 O COLLOTINIE
OFF CbLLI510N 1 0/14125 1 5:20
NARRATIVE
25-8897 ACC
On 10/14/2025 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 vehicle versus pedestrian collision in the intersection
of Edmonds Ave NE and NE Sunset Blvd Renton/King/WA.
I arrived on scene and located both involved parties, the pedestrian advised he had some minor
scrapes and bruises. RRFA responded for an evaluation.
The driver of the 2025 Honda Pilot WA/CPR2333, was identified by her WADL as Celina C Sturdivant
DOB: 5/2/1982. Celina said that she was in the left turn lane to turn from southbound Edmonds Ave
to eastbound Sunset Blvd. She advised she had a green turn arrow and was making her turn. She
said that she did not see the pedestrian in the crosswalk and struck him. There was damage to the
driver side front quarter panel and hood of the Pilot. Celina was not injured.
The pedestrian was identified by his WADL as Matthew H Phang DOB: 10/23/2006. Matthew said
that he was riding his small electric scooter in the crosswalk southbound crossing Sunset Blvd. He
said that he was struck in his right side. Matthew had some minor scrapes and bruises on his right
hand and hip. He was evaluated by RRFA on scene and cleared. I examined his scooter and did not
see any obvious signs of damage. Matthew said that he had a cross signal when he entered the
crosswalk.
Several witnesses stayed on scene, they advised that the collision was at an extremely slow speed
and estimated it to be around 5 mph. Matthew's friend who was also in the crosswalk with him was
identified as Ace J Hubbel DOB: 11/19/2008. He advised they had a cross signal when they entered
the crosswalk.
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 10/15/2025 Renton WA
PAGE 3 OF 4
REPORT NO. EG41005 CASE# ' 25-8897 DATE AND TIME 10/14/25 15:20
OF COLLISION
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PAGE 4 OF 4