HomeMy WebLinkAbout25-9108 )STATE
TFcN 5 0 27i t
Oc� RA EG44856
COLLISION REPRT 1591971
CASE# 25-9108 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL AGENCY 4100 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
coLLISION' 10 - 21 - 2025 1239 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
SW 43RD ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e EAST VALLEYRD
0 3 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE ❑ CYCLE ❑ YES No �/ D:4252444116 0 7 30
5 LAST NAME VERMA FIRST NAME PURSHOTTAM MIDDLE 1 2 31
INITIAL
STREET ❑ 24240 132ND AVE SE CITY KENT ST WA ZIP 980425115 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 3
INTERLOCKYEs D NOEI I INTERLOCKYE! NO YES D NO
8� LCEENSE# STATE WA SEx M MMOCSYY' 10 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CTT9401 STATE WA VN# 4T1DAACK2SU020422 3
10[9� PI ATP rt
11[—j— TRAILER STATE TRAILER ,STATE ROM TO
11 3 5 PLATE# PLATE#
rRLR TRLR 5 3 33
12 0 Q VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 9 9 34
13 3 2025 TOYT CAMRY DAMAGE YES�No ✓� YES❑ NO�
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE NSURANCE CO GEICO 6213-17-32-03
IN EFFECT &POLICY#VEHICLE 4TOP _
srgNOLN YesG ❑NO❑ CITATION# 5A0625802 CHARGE FAIL YIELD PRIVATE RD MOTOR o ooTro6 36
15
rL� MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE' ❑ ❑ nWNFR D:2065814159
16�
LAST NAME CASTELLANOS YANEZ FIRST NAME MAYRA MIDDLE (,
INITIAL
STREET �/ ❑
17 ❑ 2525 SW 322ND ST CITY FEDERAL WAY ST, WA ZIP 98023 37
NEW ADDRESS ':
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38
INTERLOCKYEs No INTERLOCK YES No YEs NO
19 DRIVER'S STATE WA SEX F I D.CB. 1 12 12 1986 ❑ 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG'2 RESTR 4 EJECT 1 ' 7 HELMET INJURY NATURE OF INJURIES ❑ 40
USE CLASS MINOR BACK PAIN
21 LICENSE CLX0679 TATE WA VIN# 3C6TRVAG9JE135389 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 201$ MAKE RAM MODEL PROMAS STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2
SHADE IN DAMAGEAREA
2 3
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 000340041
IN EFFECT &POLICY# t 9TOP 5
veeiae ,J—I CITATION# CHARGE tO BOTTOM
LecnLLY YES N`.LJ
25 s 7 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG44856
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9108
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. — L----------�
MMDDYYYY
PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----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.
C.ARNOLD 10-21-25 01:50 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 11/4/2025 12:04:10 PM
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 12:44 PM TIME POLICE ARRIVED 12:53 PM
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47
REPORT NO.` EG44856 CASE# 25-9108 OLI?TIME
OF 10/21/25 12:39
COLLISION
NARRATIVE
CC 25-9108
On 10/21/2025 at 1244 hours I was dispatched to a motor vehicle collision at the intersection of SW
43rd St and East Valley Rd in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was traveling East on SW 43rd St in the #1 lane just past East Valley Rd on
the East side of the intersection. Driver 2 stated that she came to a stop for a metro bus that was
stopping to discharge/pick-up passengers.
Driver 1 stated that he was in the parking lot of the Shell gas station located at 18010 East Valley
Highway preparing to turn right onto SW 43rd St to proceed East on SW 43rd St.
Collision
Driver 2 stated that while she was stopped, Unit 1 began it's lefthand turn and the front drivers side
bumper of Unit 1 collided with the rear passenger side bumper of Unit 2.
Driver 1 stated that he was looking at the vehicle behind Unit 2 and saw that the driver was waving
him through. Driver 1 stated that he began driving forward and did not expect Unit 2 to stop where it
was at. Driver 1 stated that the front drivers side bumper of Unit 1 collided with the rear passenger
side bumper of Unit 2.
Injuries
Driver 2 complained of slight back pain that was exacerbated from a previous collision.
Vehicle Disposition
Both vehicles were operational
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because the driver of a vehicle about
to enter or cross a highway from a private road or driveway shall yield the right-of-way to all vehicles
lawfully approaching on said highway. Had Driver 1 yielded to the right of way of Unit 2, this collision
would not have happened.
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 Officer C. Arnold #12509 at 13:41 on 10/21/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG44856 CASE# 25-9108 DATE AND TIME i 10/21/25 12:39
OF COLLISION
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PAGE 4 OF 4