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HomeMy WebLinkAbout25-10019 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG54762OLCERA COLLISION REPORT 1591971 CASE# 25-10019 2 INTERSTATE ❑ CITY STREET❑ Ell STATE ROUTE OTHER LOCAI-AGENCY 4200 3 C©DIN6 COUNTY RD PRIVATE WAY 2❑ TRIBAL UN TS#OF 02 STRUCK 1 8 28 1 OBJECT TREE OR STUMP i RESERVATION : 1 1 2❑3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF N E IN eDLLISION' 11 - 18 - 2025 0647 17 =.= S 8 W❑ OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLOMAPLE VALLEY HWY MILE POST e 14800 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 C------�.� FEET e S B W 2 0 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:7076159064 0 1 30 5 LAST NAME TRUJILLO FIRST NAME ANDREW MIDDLE O 1 1 2 31 INITIAL STREET ❑ 4521 RENTON AVE S '.NEW ADDRESS CITY I $EATTLE ST' WA ZIP: 981081648 2 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYES NO INTERLOCKYES NO YEs NO 8❑ DCIENSE# STATE WA SEXI M MMDDYY' O6 — 28 — 2003 1 2 32 9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET INJUR CLASSY 14 1 NATURE of INJURIES 2❑ LICENSE, CNH6866 STATE WA VIN# WVWFV71K38WO43065 3 10 Fq I as ATP rt 11 5 0 TRAILER STATE TRAILER STATE PLATE# PLATE# FROM To TRLR rRLR 7 1 3 33 12 5 0 VIN#' VIN# FROM TO VEH.YEAR 2008 MAKE VOLK MODEL GTI STYLE VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 7 $ 34 13� DAMAGE YES II_II NO `/ YESII_I) NO REGISTERED OWNER INFO ANDREW TRUJILL01521 RENTON A VE S SEA TTLE WA 981081648 D:7076159064 VEHICLE NO. 1 SHADE IN DAMAGED AREA 35 14 LIABILITY INSURANCE❑ INSURANCE CO GEIC04169 846815 IN EFFECT &POLICY# 9TOP _ YEs sE"ALLY ❑NO❑ CITATION# 5A0900764 CHARGE INATTENTIVE DRIVING s a oorrob s 36 15❑ MOTCYR PEDAL- PEDESTRIAN1:1 PROPERTY DAM THR OLD MET PHONE UNIT 02 VEHICLE CYCLE nWNFR YES�/ NO D:4257616278 16� LAST NAME CAMARA FIRST NAME MARLEY MIDDLE A INITIAL 17 STREET ❑ 37 NEW ADORE SS❑ 21651 SE 266TH PL CITY I MAPLE VALLEY ST, WA ZIP 980386122 1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 38 INTERLOCKYEs No INTERLOCK YES Ne YEs NO 19 DRIVER'S STATE WA SEXI M I D.O.B. 07 11 2005 39 LICENSE# MMDDYY — HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY� STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICEN E LATEICCM9643 rare WA vIN# WDBUF65J43A207427 41 22❑ PLATE# STATE PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2003 MAKE MERZ MODEL E STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES �/ No GENE MEYER REGISTERED OWNER INFO DANA ARRITOLA 21651 SE 266TH PL MAPLE VALLEY WA 98038 VEHICLE NO.2 SHADF�DA GE,�,AREA LIABILITY INSURANCE� INSURANCE CO SAME. �$ ��dd IN EFFECT &POLICY# 4.`dTOP VEHICLE ❑ CITATION11 CHARGE G�760TTOM L,—LY YES N 25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 M.LEVERTON 2517 WA0171300 ❑ PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG54762 COLLISION REPORT III III III III III 111 1591972 CASE# 25-10019 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. M.LEVERTON 11-18-25 09:39 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED APPROVED BY DATE C.JACOBS 1953 12/3/2025 7:52:14 AM BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 6:48 AM TIME POLICE ARRIVED i 6:56 AM PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4 REPORT NO. EG54762 CASE# 25-10019 O OF COLLI 510N TIME 11/18/25 06:47 COLLISION NARRATIVE blk/1 lane 2 inattn swerved for slowing/stopped pitted slv slv off roadway hit 2 trees CC Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash about the 14800 block of Maple Valley Hwy. When I arrived I noticed heavy damage to the grass and two trees on the south side of the highway. These marks lead directly to unit 2 which remained off road and was an obvious total loss from damages with a large debris field strewn about. I contacted unit 2 who told me he was eastbound (south) on MVH lane #1 when unit 1 hit him in the driver side back passenger door forcing him off the roadway. He slid in the ditch/grass/hit two trees and came to rest off the road. He did complain of an abrasion on his ankle but declined to be checked by Fire. His vehicle required a flatbed tow truck for damages. I contacted unit 1 ID'd by his picture WADL. He told me he that he was going forward, eastbound, lane #2 and at the last minute realized traffic in front of him was rapidly slowing/stopping. He told me he panic braked and swerved to the right striking unit 2 and sending him off the roadway. He was able to recover his vehicle and move it off the roadway. He did not complain of injury and damages did not require a tow truck. I cited unit 1 Ref RMC 10-12 25 Driver Inattention 2 vehicle crash via complaint. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. M.Leverton/2517 City of Renton/King/Wa 11/18/2025 PAGE 3 OF 4 REPORT NO. EG54762 CASE# 25-10019 DATE AND TIME 11/18/2506:47 OF COLLISION mol � t c u {s fit zt T" r h l � l t �A { 2 t 1 yy f U= 0 Wf f 3 lt� ' t r d t��< 1 f PAGE 4 OF 4