HomeMy WebLinkAbout25-9045 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG44815 STATE OF
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE ❑
CASE# 25-9045 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL AGENCY. 4200 3
COUNTY RD NVOLVED CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
UNITS#OF 02 SO BJECT TRUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coulsloN' 10 - 19 - 2025 1142 17 =.�� S W e IN
OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
TALBOT RD S BLOCK NO. e 1400 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 350 00 FEET e✓ S 8✓ W e S 15TH ST
0 4 29
MOTtlR ✓ PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES NO ✓ O 1 30
5 LAST NAME AUDSLEY FIRST NAME BLAKE MIDDLE I W 1 1 2 31
INITIAL
STREET 1:1 6023 SW STEVENS ST 306 CITY SEATTLE ST WA ZIP 98116 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCKYEs NO✓ INTERLOCKYEs No✓ YES No✓
8❑ LICENSE# STATE WA SEX M MMOCSYY' 08 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
10 LI ENSE'ti�, N/A sTArE VN# 1FTER4HHOSLE43733 3
TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# ROM TO
rRLR TRLR 1 3 33
12 3 5 VIN# vN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 2 2025 FORD RANGE PK DAMAGE YES NO ✓ YEs� No✓ 1 5 34
REGISTERED OWNER INFO (NEW] VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
14 ✓ STATE FARM 5896728C0447
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE I 5 36
LEcgLLY YES❑NO❑ CITATION# 7 o BOTTOM
15❑ EIGA o c s 7
UNIT 02 MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 VEHICLE CYCLE. nWNFR YES✓ NO
16�
LAST NAME AKAU FIRST NAME TURNER MIDDLE Z
17 F1
STREET ❑
'� 2020 GRANT AVE S J201 CITY I RENTON ST, WA ZIP 980 INITIAL 55 4 37
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED' 38
INTERLOCKYEs No✓ jNTERLOCK YES No✓ vEs NO
19 DRIVER'S STATE WA SEX M MDDY 10 18 1991 39
LICENSE# MO.BY —
20❑ ON DUTY STATUS' AIRBAG'3 RESTR 4 EJECT 1 H U ET INJ RY; 1 NATURE OF INJURIES � 40
21 ILICENSE PATE# APM5247 TATE WA VIN# 1 HGCR2F34EA260789 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2014 MAKE HOND MODEL ACCORD STYLE $D VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO,2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 4527308F1247
IN EFFECT &POLICY#waE LJ
CITATION CHARGE
LvEecnLLY YES❑ N C199,
25
a a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG44815
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9045
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME WELLS AUSTIN
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE# SEX' M DOB
UNKNOWN MMDDYYYv 06
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
�, 1 POS. 9 2 4 1 USE CLASS 11 ---�
'NAME
(LAST FIRST,MIDDLE INITIAL) AUDSLEY HIND H
ADDRESS&PHONE# D C,B
6023 SW STEVENS ST 306 SEATTLE WA 98116 SEX' F MMDDVVYv 02 — 04 — 1974
SEAT HELMET INJURY
NATURE OF INJURIES
PASSENGER �WITNESS UNIT# i 1 POS. 3 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M —T L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. USE CLASS r— ----j
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.
STEVEN FAJARILLO 10-27-25 05:59 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 11/4/2025 9:36:01 AM
BADGE OR ID# 9Y847 ORI#' f WA0171300 TIME POLICE DISPATCHED'; 11:44 AM TIME POLICE ARRIVED 11:46 AM
PART B 3 Do-3mx-,aR(Burls) PAGE 27 OF 47
REPORT NO.` EG44815 CASE# 25-9045 O COLLI COLLISION TIME
OF 10/19/25 11:42
COLLI
NARRATIVE
25-9045
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 10-19-2025 1 was working as a police officer in the city of Renton. At approximately 1144 hours I
was dispatched to the report of a blocking collision at the intersection of Talbot Rd S/S 15th St, City of
Renton, County of King, WA. This incident was captured on my department issued Axon body
camera.
According to the notes in the call, a two-vehicle collision occurred.
I arrived on scene at the 1400 block of Talbot Rd S. Both vehicles were moved out of the roadway. 1
confirmed there were no injuries. No vehicles needed to be towed.
I spoke with the driver of Vehicle 1. He was on a test drive with the vehicle from Sound Ford. He was
driving south on Talbot Rd S. He was in the inside turn lane taking a left when the rear driver side
bumper collided with the front passenger bumper of Vehicle 2.
1 spoke with the driver of Vehicle 2. He advised he was driving south on Talbot Rd S in the inside turn
lane. Vehicle 1 started to make a left turn from the outside turn lane. This is when the collision
occurred.
I photographed both vehicles. I provided case numbers to both parties. Both vehicles were parked in
a private lot and did not request impound.
Based on the facts regarding this collision Vehicle 1 turning left from the outside turn lane was the
proximate cause of the collision.
There is no further information available at this time.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Fajarillo #12847 on 10/27/2025 @ 0549 hours in Renton WA.
PAGE 3 OF 4
REPORT NO. EG44815 CASE# 25-9045 DATE AND TIME i 10/19/25 11:42
OF COLLISION
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