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OOLCERAF EG44829
COLLISION REPRT 1591971
CASE# 25-9281 2
INTERSTATE CITY STREET FIRE ❑
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 - 27 - 2025 0617 17 =.= S 8 W e IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO.
RAINIER AVE S
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�. FEET S 8 W e S 7TH ST
2 0 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE ❑ CYCLE ❑ YES No �/ D:2533263859 0 1 30
5 LAST NAME MAULDIN FIRST NAME WILLIAM MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 702 W VALLEY HWY N CITY ALGONA ST WA ZIP 980014117 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES No INTERLOCK YES Na YES NO
g DOIENSE STATE WA SEX M MMOCSYY' 07 - 29 - 1980 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, CPX2983 STATE WA VN# 5YJ3E1EAOSF984339 3
10 PI ATP rt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# HEW TO
TRLR TRLR 5 1 33
1 3
FROM TO
2 5 VIN# vI.
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 3 2025 TESL MODEL DAMAGE YES�No ✓� ves❑ 5 1 34
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14� LIABILITY INSURANCE NSURANCECO STATE FARM 579 8704-D16-47
IN EFFECT &POLICY#VEHICLE
4TOP
srgNOLNG Yes❑NO❑ CITATION# 5A0625821 CHARGE IMPROPER LANE USAGE s o ooTrom z 36
15
MOTOR PEDAL PHONE
UNIT PEDESTRIAN D:20 VEHICLE CYCLE67717904 OWNER
16�
LAST NAME ✓ACKSON FIRST NAME LANEA MIDDLE E
INITIAL
STREET ❑ 37
17 '❑ 9813 198TH ST E CITY GRAHAM ST, WA ZIP 983384 802
NEW AbORESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES NO INTERLOCKYES 0No YES No'
19 DRIVER'S
# STATE WA SEK F MMDDYY 03 _ 04 2004 11
39
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSECRV6691 TATE WA vIN# 1N4BL4BV0RN388174 41
PLATE#
22❑ [TILER TRAILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2024 MAKE HISS MODEL ALTIMA STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO BIENVENIDO QUERIDO 9813198TH ST E GRAHAM WA 98338 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSURANCE CO GEICO 6029856710
IN EFFECT &POLICY# 9TOP
Hiae
CITATION 11
CHARGE
LveecnLLY YES❑ NL]
25 1060TTOM
a 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. EG44829
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9281
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
NAME MAULDIN CARLYJ
(LAST,FIRST MIDDLE INITIAL}
ADDRESS&PHONE#
702 W VALLEY HWY N ALGONA WA 980014117 2533350928 SEX' F MMooYYYv 11 - 10 - 1988
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
Ej 1 Sp EAT
3 2 4 1 USE CLASS ;1
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B. -F L----------�
MMDDYYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIES
POS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B.M -F L----------�
MDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q' POS. USE CLASS r— ----�
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 10-27-25 06:55 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
11/4/2025 10:23:24 AM
C.JACOBS 1953
BADGE OR ID# 12509 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:18 AM TIME POLICE ARRIVED 6:23 AM
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47
REPORT NO.` EG44829 CASE# 25-9281 O COLLI COLLISION TIME
OF 10/27/25 06:17
COLLI
NARRATIVE
CC 25-9281
On 10/27/2025 at 0618 hours I was dispatched to a motor vehicle collision at S 7th St and Rainier
Ave S in the City of Renton, King County, Washington.
Pre-Collision
Driver 2 stated that she was in the #4 lefthand turn lane of Northbound Rainier Ave S at S 7th St
preparing to perform a lefthand turn to proceed West on S 7th St. At the time, Driver 2 state that she
was traveling straight in the lefthand turn lane.
Driver 1 stated that he was in the #3 lane traveling North on Rainier Ave S approaching S 7th St.
Collision
Driver 2 stated that as she was going straight ahead in the #4 lefthand turn lane, Unit 1 swerved from
the #3 lane into the #4 lane and the rear drivers side of Unit 1 collided with the front passenger side
wheel of Unit 2.
Driver 1 stated that there was a vehicle in front of him that suddenly slammed on their brakes, and he
swerved to avoid a collision by maneuvering into lane #4 where Unit 2 was already occupying. Driver
1 stated that the rear drivers side of Unit 1 collided with the front passenger side wheel of Unit 2.
Injuries
None reported.
Vehicle Disposition
Both vehicles were operational.
Proximate Cause
I determined that Driver 1 is the proximate cause of this collision because a vehicle shall be driven as
nearly as practicable entirely within a single lane and shall not be moved from such lane until the
driver has first ascertained that such movement can be made with safety.
Driver 1 was cited per RCW 46.61.140.
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 06:48 on 10/27/2025 in the City of Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG44829 CASE# 25-9281 DATE AND TIME i 10/27/25 06:17
OF COLLISION
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PAGE 4 OF 4