HomeMy WebLinkAbout25-9551 II III III IIIII IIII III II I SUPPLEMENTAL
O EG49022 t 27iiT REPORT
COLLISION REPORT 1591971
CASE# 25-9551 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAI-AGENCY 4100 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF N E
eDL�ISION' 11 - 03 - 2025 1714 17 =.= S 8 W E OF IN M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOSWGRADYWAY MILE POST
e 1400 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET e✓ S 8 W e OAKSDALE AVE SW
OF11
29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2067739280 0 1 30
6 LAST NAME SIERRA CHACON FIRST NAME ANDERSON MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 1100 SUNSET BLVD NE,APT A102 CITY; RENTON ST WA ZIP; 98056 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO IN7ERLOCKYEs NO YES NO
8❑ DRIVER # STATE WA SEXI M MMDDYY' 05 - 17 - 1995 1 2 32
9� ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, CNJ1206 STATE WA VIN#; 1C4PJLCB4GW256398 3
10 Fl I PI ATF rt
TRAILER
11 0 0 STATE TRAILER STATE PLATE# PLATE# ROM To
TRLR rRLR. 7 1 3 33
12 0 0 VIN#' vIN#
FROM TO
VEH.YEAR 2016 MAKE JEEP MODEL CHERO STYLE UT VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34
13� DAMAGE YES II_II NO `/ YESII_I) NO
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE El
NSURANCE CO IQ
4
IN EFFECT &POLICY# CHARGE 11
36
LEGALLY YES❑NOCITATION# t15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR YES�/ NO D:2067014121
16�
LAST NAME ODOH FIRST NAME ROSEMARY MIDDLE N
INITIAL
17 F1 STREET ❑
❑ 10013 SE 219TH P! CITY KENT ST, WA ZIP 98031 q 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38
INTERLOCKYEs ND INTERLOCK YES NO YEs NO
19 DRIVER'S '
MMDDYY —
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURYIT] NATURE OF INJURIES 40
USE CLASS CHEST PAIN
21 LICEN E LATEICLV8224 rare W/a vIN# 5TDKBRCHXRS610815 41
22❑ PLATE# STATE PLAAILER
TE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2024 MAKE TOYT MODEL H/GHlAN STYLE UT I VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO NO
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE
NQ.2
SHADE IN DAMAGEAREA
2 3
LIABILITY INSURANCE INSURANCECO STATE FARM 4566576B2247B
IN EFFECT &POLICY#VEHICLE
I STOP
E—Y YES
LEGALL ❑ N.I—I, CITATION# CHARGE to BOTTOM
L
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
KEITH PETTY 12809 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG49022
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9551
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.
KEITH PETTY 11-17-25 02:07 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 1112612025 12:11:38 AM
BADGE OR ID# 12809 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:15 PM TIME POLICE ARRIVED i 5:16 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF F5
REPORT NO. EG49022 CASE# 25-9551 DATE OF COLLI r�510NN + 11/03/25 17:14
L1
NARRATIVE
25-9551
On 11/03/2025 at approximately 1716 hours, I was dispatched to the 1400 block of SW Grady Way in
the City of Renton, County of King, State of Washington for an accident with injuries.
Unit 1 driver was Anderson Jose Sierra Chacon (DOB 05/17/1995). Anderson was driving his silver
2016 Jeep Cherrokee (CNJ1206/WA) VIN/1C4PJLCB4GW256398.
Unit 2 driver was Rosemary Nkechi Odoh (DOB 01/20/1963) driving her white 2024 Toyota
Highlander (CLV8224/WA) VIN/5TDKBRCHXRS610815.
Unit 1 stated through a Spanish interpreter that he was traveling east bound on SW Grady Way in
lane 1. He did not see traffic slowing and saw unit 2 stop quickly. He did not have time to stop and
collided into the back of unit 2. The collision causing over$1000 in damage.
Unit 2 stated that she was heading east bound on SW Grady Way when she came to a stop in traffic
at the 1400 block. The traffic was backed up from the signal at the SW Grady Way and Oaksdale Ave
SW intersection. While she was waiting, unit 1 collided into the back of her vehicle.
Unit 2 complained of chest pain and was evaluated on the scene by RRFA. She was cleared at the
scene and left in her vehicle.
Both vehicles were able to drive away on their own.
I cited Anderson (unit 1) by mail for violating RCW 46.30.020-Liability Insurance as no person may
operate a motor vehicle subject to registration under chapter 46.16A RCW in this state unless the
person is insured under a motor vehicle liability policy with liability limits of at least the amounts
provided in RCW 46.29.090, is self-insured as provided in RCW 46.29.630, is covered by a certificate
of deposit in conformance with RCW 46.29.550, or is covered by a liability bond of at least the
amounts provided in RCW 46.29.090. Proof of financial responsibility for motor vehicle operation
must be provided on the request of a law enforcement officer in the format specified under RCW
46.30.030.
This incident was captured on my body worn camera. This report is a summary of the events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized
"I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct."
Electronically signed: K.Petty, Date: 11/03/25at 1817 hours, Place: Renton, King County, WA
PAGE 3 OF 5
REPORT NO. EG49022 CASE# 25-9551 OATS OF COLLI r�510NN + 11/03/25 17:14
L1
NARRATIVE
PAGE 4 OF 5
REPORT NO. EG49022 CASE# 25-9551 DATE AND TIME 11/03/25 17:14
OF COLLISION
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