HomeMy WebLinkAbout25-9191 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG44824OLCERA
COLLISION REPORT 1591971
CASE## 25-9191 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL A`GENC'Y 4200 3
COUNTY RD INVOLVED CODING
PRIVATE WAY
2❑ TRIBAL UNITS#OF 02 SO TRUCK 5 1 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E
coLLISION' 10 - 23 - 2025 1517 17 �.�� S WE IN
OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
DUVALL AVE NE BLOCK NO. e 1700 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
6 80 00 FEET e✓ S 8✓ W e NE 17TH ST
OF 4 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE YES ✓NO 2 O 30
6 LAST NAME SANCHEZ BAUTISTA FIRST NAME ANA MIDDLE B 1 1 2 31
INITIAL
STREET 1:1 29015 18TH AVE S CITY FEDERAL WAY ST WA ZIP 98003 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO INTERLOCK YES NO YES F No
8 DCIENS STATE MM SEx X MMDrYY' 04 — 12 — 1995 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELM USEET CLASS 1 NAruRE of INJURIES 2
LICENSE, CJW0445 STATE WA vN# 1FM5K8F89DGA59780 3
10[9� PI ATP tt
11[-j- TRAILER STATE TRAILER ,STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TRLR 3 5 33
12 3 5 VIN# vI.
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 2 2013 FORD EXPLOR DAMAGE YES DNO ✓ YEs_ No 1 5 34
REGISTERED OWNER INFO FLORENTINA OLMEDO-SORIANO 2901518TH AVE S=52 744 348 9335 FEDERAL WAY WA 98003 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO IQ
4
IN EFFECT &POLICY#
v `LE CHARGE 5 36
Lec LY YES❑NO❑ CITATION# 7
15❑ sTnNowc
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 PEDESTRIAN
VEHICLE CYCLE: (7WNFR YES NO
16F]
LAST NAME MEYER FIRST NAME ELIZABETH MIDDLE' L
INITIAL
❑
17 F1 STREET'O 4419 NE 18TH CT CITY RENTON ST, yyq ZIP 98059 37
3933
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPORTED 38
INTERLOCKYE No jNTERLOCK Yrs NO vEs Ndi
19 DRIVER'S STATE WA SEX F I D,O,e. 01 04 2008 39
LICENSE# MMDDYY -
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21[—] LICENSLATE E CMC4987 TaTE WA vIN# 5NPDH4AEXDH370201 41
22❑ LATE# STATE P[TILER AILER
P ATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2Q13 MAKE HYUN MODEL ELANTRA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO KATIE MEYER 4419 NE 18TH CT RENTON WA 98059 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO SAME.
IN EFFECT &POLICY# t 9TOP
veeiae ❑ ,J—I CITATION# CHARGE tO BOTTOM
LecnLLY YES N`[
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG44824
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9191
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDYYYY
PASSENGER F-1 WITNESS El 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
blk/1 It turn boa blk/2 lane change from 2 to Itl
RTF
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at about the 1700
block of Duvall Ave NE.
I contacted the driver of unit 2 who told me she was southbound Duvall Ave NE and attempting to
change lanes from lane 2 into the left turn lane when she was contacted by unit 1. She did not
complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 who told me she was in a borrowed car and driving with her Mexico DL.
She said she was making a left turn from a business complex near Bank of America. She was turning
into the left turn about the same time unit 2 was merging over into the turn lane. She did not complain
of injury and damages did not require a tow truck.
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
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 12:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 111412025 10:52:25 AM
BADGE OR ID# 2517 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 3:17 Pry TIME POLICE ARRIVED 3:19 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG44824 CASE# 25-9191 DATE AND TIME 10/23/25 15:17
OF COLLISION
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