HomeMy WebLinkAbout25-80235 )STATE
TFcN 0 $ 27i 1
Oc� RA EG54560
COLLISION REPRT 1591971
CASE# 25-80235 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOL`CO A`GENC'Y 4100 3[--�
COUNTY RD INVOLVED CODING
2❑ TOTAL 1
PRIVATE WAY
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
GDLL.ISION'. 11 - 28 - 2025 1324 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION Z NON INTERSECTION ❑
140TH WAY SE BLOCK NO.
❑
MILE POST e
4a
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 FEET e S 8 W e MAPLEVALLEYHWY
0 1 29
MOTtlR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO D:9729892567 0 1 30
6❑ LAST NAME CURRY FIRST NAME TONI MIDDLE L 1 2 31
INITIAL
STREET ❑ 15202 140TH WAY SE CITY RENTON ST WA ZIP 98058 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO✓ INTERLOCKYEs NO✓ YES No�/
8❑ DRIVER'CENS # STATE WA SEX F MMOCSYY' 11 — 29 — 1960 1 2 32
— JURIE
9 ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF NSOF 2
USE ;CLAsg COMPLAINTS OF LEG AND CHEST PAIN
10 9 LICAErNES�E, BZK6089 STATE WA VIN# JN8AT2MT2GW029233 3
11[-j— TRAILER STATE TRAILER ,STATE RON To
11 0 0 PLATE# PLATE#
rRLR TRLR 7 3 33
12 0 0 VIN# VIN
( FROM TO
VER YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN 7 v GOVT VEHICLE 1 $ 34
13 4 2016 N/SS ROGUE Sp DAMAGE YES ONO � �MEYERS ves❑ No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ INSURANCE CO 3 4
✓ PROGRESSIVE 865838039
IN EFFECT &POLICY# 4TOP 5
v `Le CHARGE BOTTOM 36
Lec Ly YES❑NO❑ CITATION# $
15❑ STM INc Y e
UN# MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
1 T 02 VEHICLE CYCLE. nWNFR YES'I
NO
16�
LAST NAME KALLBERG FIRST NAME ROMAN MIDDLE A
INITIAL
17 STREET'❑ 22509 152ND AVEA VE SE CITY KENT ST, Wq ZIP 98042 4 37
NEW ADDRESS
18� CDL IGNITION REQUIRED IGNTION PRESENT MEDIOALTRANSPORTED' 38
INTERLOCKYES No✓ fNTERLOCKYEs No✓ ES NO I✓
19 DRIVER'S STATE WA SEX M DO.B. 05 17 2006 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG g RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE OF INJURIES 40
USE CLASS BLEEDING FROM ARM
21 LICENSLATE E D48570A rarE WA vIN# USE
41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR r RLR 43
UIN#. 'IN#.
VEH.YEAR 2008 MAKE TOYT MODEL TACOMA STYLE PK VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24 DAMAGE YE
s�/ NO GENE MEYERS YES No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO,2
SHADE DEGEeoAREA
LIABILITY INSURANCE INSURANCECO STATEFARM3646621A1647D AAA
IN EFFECT &POLICY# C�TOP
vewaE YES❑ N,.I—J I CITATION# CHARGE iCD BOTTOM
�ECA��Y
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
ALEX IURCO 13169 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG54560
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80235
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.
ALEX lURCO 11-28-25 06:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 12/2/2025 3:43:31 PM
BADGE OR ID# 13169 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 1:24 pM TIME POLICE ARRIVED 1:34 PM
PART B 3 Do-3mx-,ao(Rtrras) PAGE 27 OF 47
REPORT NO.` EG54560 CASE# 25-80235 O COLLI COLLISION TIME
OF 11/28/25 13:24
COLLI
NARRATIVE
On 11/28/2025 at approximately 1324 hours, I was dispatched to an unknown injury accident located
at Maple Valley Hwy and 140th Way SE within the City Limits of Renton, County of King, State of
Washington.
While en route, I was advised that this was now an injury accident and that the Renton Fire
Department would be responding as well.
Upon my arrival, the Fire Department was on scene and treating all complaints of injury.
While they were doing this, I spoke to a witness, an off-duty Police Officer, he identified himself as
Terry L. Cobb (DOB 05/08/1992). He stated the below:
The driver and only occupant of unit#1 was stopped at an intersection with no traffic signals, she had
to yield to a vehicle already in the intersection. She was attempting to turn left (northbound) onto
140th Way SE and believed that she had no vehicles coming from her left. She pulled out into the
intersection where she struck the driver and only occupant of unit#2, who was heading southbound
on 140th Way SE. This caused the collision which resulted in significant damage to both vehicles.
Unit#2 is said to have rolled at least once.
I spoke to the driver of unit#1 identified as Toni L. Curry (DOB 11/29/1960), and she stated that she
was looking to the left while in the intersection and believed there was no vehicle there, she pulled
out and noticed the vehicle of unit#2, Roman A. Kallberg (DOB 05/17/2006) coming towards her, she
believed that Roman would stop in time, but he did not.
I spoke to the driver of unit#2, Roman, and he stated that he was heading southbound onto 140th
Way SE, he was in "2nd gear" and going up the hill when unit#1 collided with him, causing his
vehicle to roll at least once.
Roman was driven to the hospital by his father.
Both Unit#1 and Unit#2 had to be towed due to extensive damage. An exchange of information was
provided to all involved parties.
I believe that unit#1 is the proximate cause of the collision, unit #1 should have been paying better
attention to her surroundings before driving into an intersection.
Both parties received the case number associated to this collision.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically Signed, A. lurco 13169, 11/28/2025 @ 1432 hours.
PAGE 3 OF 4
REPORT NO. EG54560 CASE# 25-80235 DATE AND TIME i 11/28/25 13:24
OF COLLISION
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