Loading...
HomeMy WebLinkAbout25-9872 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG48301oc� RA COLLISION REPORT 1591971 INTERSTATE CITY STREET El CASE# 25-9872 2 STATE ROUTE OTHER LOCAI-AGENCY 42QQ 3 C©DIN6 COUNTY RD PRIVATE WAY 2 3 TOTAL#OF OBJECT 1 1 a 28 TRIBAL UNITS OZ STRUCK TREE OR STUMP RESERVATION I 1 1 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E eDLLISION' 11 - 13 - 2025 1752 17 =.�� S W OF 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑ BLOCK NO. 4050 MAPLE VALLEY HW 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �.� FEET e S8 We 131STAVESE 2 0 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2538802128 0 1 30 5 LAST NAME JONES FIRST NAME BRIGITTA MIDDLE R 1 1 2 31 INITIAL STREET ❑ 12680 SE 169TH PL CITY; RENTON I ST WA ZIP; 980586133 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES No✓ INTERLOCKYES Nd✓ vEs NO✓ 8 DRIVER # STATE WA SEXI F MMDDYY' 03 - 14 - 1961 1 2 32 -NJUR 9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 CLASSY 1 [NATURE of INJURIES 2 10 LI ENSE', BWE3974 STATE WA VIN# 5TDKZ3DC4HS851134 3 TRAILER STATE TRAILER STATE 11 4 5 PLATE# PLATE# ROM To TRLR TRLR 3 1 7 33 12 4 5 VIN# vIN# FROM TO VEH.YEAR 2017 MAKE TOYT MODEL SIENNA STYLE VN VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 3 7 34 13 DAMAGE YES II_II NO YESII_I) NO✓ REGISTERED OWNER INFO BR1GITTAJONES12680SE169THPL RENTONWA98058 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 4 LIABILITY INSURANCE INSURANCE CO 14 STATE FARM 590 4846 C23 47 IN EFFECT &POLICY# 9TOP v""' CHARGE t 5 36 ""ALLY yes❑NO❑ CITATION# t a 80TFOM 15❑ STM ING s 7 e MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:2065525645 16� LAST NAME DAY FIRST NAME SHELBIE MIDDLE I A INITIAL 17 STREET ❑ 37 NEW ADORE SS❑ 16831 190TH AVE SE CITY RENTON ST, WA ZIP 980580812 4 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYES No✓ INTERLOCI£YES NO✓ YEs NO'✓ 19 DRIVER'S MMDDYY — 20❑ ON DUTY❑ STATUS AIRBAG 3 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40 21 LICENSE I PATE# CBE5299 TATE WA VIN# WVWDR71K37W206694 41 22❑ PLAILER TE# STATE PLATE# STATE 42 23 TRLR r RLR 43 UIN#. 'IN# VEH.YEAR ZQQ7 MAKE VOLK MODEL RA$$lT STYLE SD VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES �/ No GENE MEYER TOWING E No✓ REGISTERED OWNER INFO SHELBIE DAY 16831190TH AVE SE RENTON WA 98058 VEHICLE NO.2 SHADE dN DAMAGED AREA 4� 3 4 LIABILITY INSURANCE INSURANCE CO GEICO 6054 66 00 86 IN EFFECT &POLICY# 9TOP V—LY ❑ N,J—I CITATION# CHARGE t060TTOM EEGnE YES 25= OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY 26 KEVIN PETERSON 12808 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG48301 COLLISION REPORT III III III III III 111 1591972 CASE# 25-9872 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 NJURY NATURE OF INJURIES POS. ' USE CLASS 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 I was dispatched to a vehicle collision on 11/13/25 at the intersection of Maple Valley HWY and 131st Ave SE, in city Renton, King County WA. Unit 1 BWE3974 Driver: Brigitta R. Jones (DOB 03/14/1961) Unit 2 CBE5299 Driver: Shelbie A. Day (DOB 02/23/2000) Upon arriving I could see a vehicle into a tree in the parking lot of the golf course. Upon speaking to Unit 1 driver, she told me that she was traveling West on Maple Valley HWY in lane 2. When approaching the intersection of 131 st Ave SE and Maple Valley HWY she went to switch into lane one when she collided with Unit 2. She stated she did not see anyone in the lane but was hit by unit 2. 1 spoke to the driver of Unit 2 who was very shaken up by the hit to the tree. She told me not sure what lane she was in she was traveling West in what she believes the right lane when Unit 1 cut her off as she was approaching the intersection of 131 st Ave SE and Maple Valley HWY. She then collided with Unit 1 where she ended up hitting the tree. Renton Fire came to the scene and evaluated both drivers due to airbag deployment and the accident into the tree. 1 completed an information exchange, and both parties got a copy. No injuries were reported 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: Officer Kevin L. Peterson Date and Place: 11/13/2025, 2243 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 11-13-25 10:56 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.BRAUN 2194 11/13/2025 11:30:14 PM BADGE OR ID# 12808 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:54 PM TIME POLICE ARRIVED i 6:06 PM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF F3 REPORT NO. EG48301 CASE# 25-9872 DATE AND TIME 11/13/25 17:52 OF COLLISION ail \w, Y k r �1 r Y S l� 1 Y k d il� u � ' its PAGE 3 OF 3