HomeMy WebLinkAbout25-9695 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG47874OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET❑ FIRE I
CASE# 25-9695 2
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4100 3
HIT&RUN CODING
❑ COUNTY RD PRIVATE WAY ❑✓ INVOLVED
2 2 TOTAL#OF OBJECT 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 11 - IN
07 - 2025 1835 17 �.[� S 8 W e OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
RAINIER AVE S BLOCK NO. e 743 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 573 00 FEET e✓ S 8 W ✓ SW 7TH ST
1 11
29
MOTOR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE
❑ CYCLE ❑ YES No �/ D:2069415437 30
5 LAST NAME LEWIS FIRST NAME ANDRA MIDDLE t 1 2 31
INITIAL
STREET ❑ 8829 41 ST AVE S
NEW ADDRESS CITY I SEATTLE ST WA ZIP: 981184829 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSP?RTED 3
INTERLOCKYES No%/ INTERLOCK YEs No�/ YES NO;�/
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 09 — 29 — 1968 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY 1 NATURE of INJURIES 2
10 LI ENSE', BYJ4514 STATE WA VIN# KL4MMBS2XMB066236 3
TRAILER STATE TRAILER STATE ROM 11 1 0 PLATE# PLATE# T.
3
TRLR rRLR 7 3 33
12 jj
VIN#' VIN#
FROM TO
VEH.YEAR 2021 MAKE BUIC MODEL ENCOR STYLE $V VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34
13� DAMAGE YES II_II NO `/ YESII_I) NO
REGISTERED OWNER INFO JENNIFER DAVIS 882941STAVE S SEATTLE WA 98118 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
A LIABILITY INSURANCE NSURANCE CO 3 4
14 AARP 55PHG925079
IN EFFECT &POLICY# 4TOP
VEHICLE CHARGE 5 36
Lemur YES[:]NO[:] CITATION# i o 80TTOM
15❑ srANowc s 7 e
MOTOR PEDAL-:. pROpERTy DAM THR OLD MET PHONE
UNIT 02 PEDESTRIAN Q✓ D:3608095888
VEHICLE CYCLE OWNER YES NO
16�
LAST NAME PETERS FIRST NAME ALLISON MIDDLE R
INITIAL
17 F1 STREET ❑❑ 37 1801717TH AVENUE CT E CITY SPANAWAY ST, WA ZIP 983871944 4
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYEs No INTERLOCK YES NO vEs No
19 DRIVERS STATE WA SEX F I D.O.B. 08 09 2002 � 39
LICENSE# MMDDYY —
6 HELMET INJURY 6 NATURE OF INJURIES 3 40
20❑ ON DUTY STATUS 3 AIRBAG RESTR EJECT 2 ❑
USE CLASS BLEEDING KNEE,SCRATCH
LICENSE
21 PLATE# TArE VIN# 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 1 7 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
YemcLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGAEEY YES NC
25 s s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JAMAA!KEARSE 12994 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG47874
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9695
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
POS. ' USE GLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I 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.
JAMAAL KEARSE 11-07-25 10:02 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 1111312025 12:46:47 AM
BADGE OR ID# 12994 ORI# WA0171300 TIME POLICE DISPATCHED 6:37 PM TIME POLICE ARRIVED i 6:44 PM
PAST Ba as-mx-at s gtxtrrasp PAGE 2�OF 4
REPORT NO. EG47874 CASE# 25-9695 DATE OF COLLI r�510NN + 11/07/25 18:35
L1
NARRATIVE
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not an exact sequencing of events.
On 11/7/2025, at approximately 1837 hours I was dispatched to a report of a vehicle v. pedestrian
collision in the Walmart parking lot located 743 Rainier Ave S. Dispatch advised pedestrian walking in
parking lot and was hit by a vehicle. A 23-year-old female was hit from behind and pushed forward
hitting her head on her cart. Female bleeding from her knees.
At approximately 1844 hours I arrived on scene. I contacted the pedestrian who was later identified
as Allison R. Peters 8/9/2002 via WADL. Allison was sitting on the curb holding her head. Allison was
bleeding from her forehead and her left knee. Allison advised she was walking in the parking lot near
the front of the store. She was walking past the handicap parking spot and started to cross over into
the aisle to get to her car on the other side. Out of no where she felt Unit 1 hit her from behind
pushing her forward causing her cart to hit the curb. She lost her balance and hit her head on the cart
as she fell into the bushes. Allison had complaints of pain to her knees and a headache. Renton Fire
evaluated Allision. Allison was transported to Valley Medical Center.
I contacted the Driver of Unit 1 who was identified as Andra Lewis DOB 9/29/1968 via WADL. I asked
for Andra's license, registration, and proof of insurance and he provided all three documents. Andra
advised that he was parked in the handicap parking spot near the front of the store. The parking spot
was perpendicular to the store and other parking spots. Andra advised there were a few cars backing
up towards his car and he didn't want them to hit him so he started to drive forward to exit his parking
spot. He didn't see Allison who was walking on his left and began to cross in front of his car to get to
her car across the parking aisle. He struck Allison from behind with the front drivers side bumper of
Unit 1.
I provided Walmart security with an Axon link to uploaded video footage of the collision. At the time of
this report I have not received any video yet.
took photos and uploaded them to evidence.com.
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 J. Kearse #12994 11/7/2025 2128 Hours Renton, King County,
Washington
PAGE 3 OF 4
REPORT NO. EG47874 CASE# 25-9695 DATE AND TIME 11/07/25 18:35
OF COLLISION
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PAGE 4 OF 4