HomeMy WebLinkAbout25-7100 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG50774OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-7100 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 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 IN eDL�ISION' 08 - 14 - 2025 13?5 17 =.= S 8 W E OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOSIN GRADYWAY MILE POST
e 1400 .�
4a❑ MILE POST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FEET e✓ S 8 W e OAKESDALE AVE SW
2 0 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2533026580 0 1 30
5 LAST NAME O'BRYAN FIRST NAME FLORDELIZA MIDDLE F 1 1 2 31
INITIAL
STREET ❑ 401 CENTAURUS AVE SW CITY; OCEAN SHORES ST WA ZIP; 985699652 2
NEW ADDRESS
7❑ CDL IGNITION REOUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO✓ (NTERLOCKVEs No✓ YES NO;✓
8 DRIVER # STATE WA SEXI F MMDDYY' 1 2 32
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY ? NATURE of INJURIES 2
10 PI ENSttEI BPT4918 STATE WA VIN# 2T2BZMCA9KC175815 3
TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE#
TRLR TRLR. 7 3 33
12 3 5 VIN# vIN#
FROM TO
13 4 VEH.YEAR2019 MAKE LEXS MODEL RX STYLE UT VEHICLE TOYED NO�iS46LIN Tv4 EBYMEYERS GOSI—`—I VEHICLE
Np✓ 7 3 34
DAMAGE IIII._IIII II�JI
REGISTERED OWNER INFO FLORDELIZA O'BRYAN 40f CENTAURUS AVE SW OCEAN SHORES WA 98569 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE INPOLICY#SURANCE CO 2 3 4
14 Z SAFECO H2161483
IN EFFECT &
11
VEHICLE CHARGE 5 36
Lemur yes❑NO❑ CITATION# OUR
15❑ sTnNowc
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY PHONE
DAM THR OLD MET N
UNIT VEHICLE CYCLE nWNRR : YES�/ NO D:2067721522
16�
LAST NAME WINDERS FIRST NAME HUGH MIDDLE I W
INITIAL
17 F1 STREET ❑❑ 10624 CRESTWOOD DR S CITY' SEATTLE ST WA ZIP 98?783?21 4 37
NEW ADDRESS
18❑ CDL IGNITION REGtU1RED IGNITION PRESENT MEDfCALTRANSPORTED 38
INTERLOCK YES ND INTERLOC(£YES R no✓ YEs NO✓
19[� DRIVER'S STATE WA SEXIM D.O.e. 02 25 1949 39
LICENSE# MMD6YY -
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H ET 2 INJURY ? NATURE OF INJURIES 40
21 LICENSLATE E C57801S TATE WA VIN# 3C63R3EL4KG627040 41
22❑ PLATE# STATE PLATE# STATE 42
23 TRLR r RLR 43
UIN#. 'IN#
VEH.YEAR 2019 MAKE RANI MODEL 3500 STYLE pi( VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO HUGH WINDERS 10624 CRESTWOOD DR S SEATTLE WA 98178 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY INSURANCE[Z INSURANCE CO SAFECO H2182518
IN EFFECT &POLICY# 9TOP
HICLE EEILe L YES❑ N,J—] CITATION11 CHARGE to BOTTOM
VE
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG50774
COLLISION REPORT III III III III III 111
1591972 CASE# 25-7100
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 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
On 8-14-25 at about 1327 1 arrived in the 1300 block of SW Grady way for a 2 vehicle (blocking)
collision. I contacted both vehicles still in the roadway. Unit 1 was in eastbound lane 2, unit 2 was in
the eastbound 2 way turn lane. Both drivers identified themselves via WADL and provided the
required paper work. Driver 2 told me that he entered the 2 way turn lane headed towards the left
turn onto Oakesdale Ave SW. Driver 2 told me she was changing lanes and did not see unit 2 prior to
the lane change. This resulted in unit 1 colliding with unit 2. No complaints of injuries.
This collision occurred in the city of Renton, County of King.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 11-18-25 04:09 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1112012025 3:05:54 PM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 1 1:25 PM TIME POLICE ARRIVED i 1:Y7 Pry
PAST B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EG50774 CASE# 25-7100 DATE AND TIME 08/14/2513:15
OF COLLISION
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