HomeMy WebLinkAbout25-80086 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG52856OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE ❑
CASE�# 25-80086 2
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE LOCAL A`GENC'Y. 4200 3
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL 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
COLLISION' 11 - 23 - 2025 1816 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION
108TH AVE SE BLOCK NO. e 19000 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET e S B W
0 4 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' YES ✓NO D:4258906509 Q 9 30
5 LAST NAME NGUYEN FIRST NAME XUAN MIDDLE T 1 1 2 31
INITIAL
STREET 11801 SE 189TH PL CITY RENTON ST WA ZIP 980587103 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 3
INTERLOCKYEs NO Z/ INTERLOCKYEs NO�/ YES D NOW
8� LICIENS# STATE WA SEX F MMoCSYY' 07 — 12 — 1949 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of NJURIEs 2=
ESBZV7682 WA 2HKW2H86MH663061 3
10 as Nrt ISTATEI
#
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# RON To
rRLR TRLR 3 5 33
12 4 Q VIN# VIN#
'.....: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE
13 4 2021 HOND CR-V SV DAMAGE YES�No ✓� Yes No� 1 9 34
REGISTERED OWNER INFO HUY TRAN 11801 SE 189TH PL RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
LIABILITY INSURANCE❑ INSURANCE CO 3 4
14 STATE FARM 5754428BO447
IN EFFECT &POLICY# 4TOP
CHARGE 5 36
Lemur yes❑NO❑ CITATION# 7 o BOTTOM
15❑ STM ING I B 7 e
MOTCYR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE' ❑ ❑ nWNFR YE:fl
No �/ D:7028443433
16�
LAST NAME WILLIAMS It FIRST NAME ERNEST MIDDLE J
INITIAL
17 F1 STREET ❑'O 37
32115 105TH PL SE APT L303 CITY AUBURN ST, WA ZIP 980924788 4
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDIGALTRANSPORTED 38
INTERLOCKYEs No INTERLOCK YES No vEs ND;�
19� DRIVER'S STATE WA SEXIM E.O.B. 04 21 1993 39
LICENSE# MMEDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H UET 2 CLAY 1 NATURE OF INJURIES 40
21� LICENS RS09798 rareGOV vIN# 1GB6G5BG3C1194586 41
22❑ PLTL ATE# STATE TILER PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2012 MAKE CHEV MODEL EXPRESS STYLE VN VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO KING CO DOT ACCESSIBLE SR 720 SENECA ST BLDG STE 107#509 SEATTLE WA 98101 VEHICLE NO,2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO ACE AMERICAN XSAH10824849
IN EFFECT &POLICY# t 9TOP
HICL
LEIAIL YES� N CL J CITATION# CHARGE tO BOTTOM
VEE
25 ----J
s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
ROBIN SMITH 12986 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG52856
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80086
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INTTIAL)
ADDRESS&PHONE#
SEX' D.O.B. — [----------�
MMDDYYYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
S ' D.O
EX .B.MMDD —F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. — L----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
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.
ROBIN SMITH 11-23-25 07:38 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 11/27/2025 12:11:55 AM
BADGE OR ID# 12986 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:33 PM TIME POLICE ARRIVED 6:33 PM
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47
REPORT NO.` EG52856 CASE# 25-80086 O COLLI COLLISION TIME
OF 11/23/25 18:16
COLLI
NARRATIVE
25-80086
Unless otherwise stated, the following occurred in the City of Renton, County of King, State of
Washington.
On 11-23-2025 at approximately 1833 hours I was dispatched to a non-injury non-blocking collision
that occurred in front of 19002 108th AVE SE. Upon arrival, 1 contacted both involved parties in the
parking lot of this address. All involved confirmed they were not injured. While on scene, 1 collected
the involved parties driving documents and their independent recollection of events leading up to the
collision.
The driver of Unit#1 said she was traveling westbound on SE 190th ST and turned southbound onto
108th AVE SE. She traveled southbound on 108th AVE SE and as she transitioned into the center
turn lane in front of 19002 108th AVE SE, she said she did not see Unit#2 in front of her already in
the turn lane. She collided with the rear of the Unit#2 as she was transitioning into the turn lane. Unit
#1 sustained damage to the front passenger side.
The driver of Unit#2 said he was facing southbound in the turn lane in the 19000 block of 108th AVE
SE preparing to turn eastbound into the driveway of 19002 108th AVE SE. Unit#1 rear ended him.
Unit#2 sustained minor damage to the driver side rear of the vehicle causing part of the bumper to
fall off.
I find the driver of Unit#1 to be the proximate cause of the collision because she failed to realize
there was a vehicle in front of her in the turn lane before she transitioned into the lane. An exchange
of information was provided to both drivers. 1 took photos of the damaged vehicles and uploaded
them to Axon. Both vehicles were able to drive away from the scene.
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 Robin Smith #12986 on 11/23/2025 @ 1931 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EG52856 CASE# 25-80086 DATE AND TIME i 11/23/25 18:16
OF COLLISION
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