HomeMy WebLinkAbout25-9239 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG55426OLCERA
COLLISION REPORT 1591971
CASE# 25-9239 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOL`CODICENC'Y 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
3I M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s on' 10 - 25 - 2025 1008 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLO1100 BRONSON WAY N MILE POST
e 1100 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 50 1.1 00 FEET e✓ S 8 W e N 1ST ST
1 9 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2068831167 1 4 30
5❑ LAST NAME FRODELIUS-FUJIMOTO FIRST NAME KELLEN MIDDLE C 0 4 31
INITIAL
STREET ❑ 2100 LAKE WASHINGTON BLVD N A 1101 CITY; RENTON ST WA ZIP; 980561455 2
NEW ADDRESS
7 +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO✓ INTERLOCK YeS Na✓ YES F NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 07 - 03 - 1990 32
9 ON DUTY❑ STATUS' AIRBAG 1 RESTR 9 EJECT 1 N USEET CLASSY',1 NATURE of INJURIES 2=
3
LICENSE
10� as ATP�' CDA7404 STATE WA vrN#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# 1ROM To
TRLR TRLR. 3 1 7 33
12 0 Q UIN#' VIN#
FROM TO
VEH.YEAR 2013 MAKE TOy. MODEL COROL STYLE 4C VEHICLE TOWED NO�iS46LIN T�VyEp,QLRS GESEE ND m 34
LE
DAMAGE II_II HtVi(t I_I
13 REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE� INSURANCE CO PROGRESSIVE 991850933
IN EFFECT &POLICY#
VEn" CHARGE 5 36
Lec Ly YES❑NO❑ CITATION# <14,
15❑ STMDING
EDAL-
MOTOR ✓ P PEDESTRIAN PROPERTY PHONE
DAM THR OLD MET NE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ nWNRR D:5099415483
16❑
LAST NAME GOMEZ FIRST NAME OCTAVIO MIDDLE N
INITIAL
17 F1 STREET ❑❑ 37 403 N 40TH AVE CITY YAKIMA ST, WA ZIP 989082669
NEW ADDRESS
1 a❑ CDL IGNITION REG]U1RED IGNITION PRESENT MEDICAL TRANSPORTED'. ❑ 38
INTERLOCKYE& uD INTERLOCK YES NO ves No
19 DRIVER'S STATE WA SEX M D.O.B. 08 13 1991 39
LICENSE# MMDDYY —
HELMET INJURY: NATURE OF INJURIES 4Q
20❑ ON DUTY❑ STATUS AIRBAG g RESTR g EJECT 9 USE 9 CLASS 0 ❑
21 LICENSE CJU1354 TATe WA VIN# 5XYK3CDF3RG142124 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2024 MAKE KIA MODEL SPORTAG STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO✓
REGISTERED OWNER INFO MARIA MORENO RAMIREZ 403 N 40TH AVE YAKIMA WA 98908 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO TRAVELERS 616547408
IN EFFECT &POLICY# 9TOP
vewaS ❑ ,J—I CITATION# CHARGE t080TTOM
,—LY YES N
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SULIASI TAMAIVENA 12788 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG55426
COLLISION REPORT III III III III III 111
1591972 CASE# 25-9239
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 0,SS ----�
: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.
SULIASI TAMAIVENA 10-25-25 03:35 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 121512025 5:40:04 AM
BADGE OR ID# 12788 ORI# WA0171300 TIME POLICE DISPATCHED 10:12 AM TIME POLICE ARRIVED i 10:13 AM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG55426 CASE# 25-9239 OF DATE AND r�N + 10/25/25 10:08
O�COLLISION
NARRATIVE
On 10/25/2025, at approximately 1008 hours, I was dispatched to an accident at 1100 Bronson Way
N, in the City of Renton, while I was employed as a uniformed Patrol Officer for the City of Renton,
County of King, State of Washington.
I spoke with the driver of unit#1, who advised that he was making a right turn from Park Ave N into
Bronson Way N in lane #1 (the lane nearest the curb). While mid-turn, his tires somehow made
contact with the sidewalk, causing his vehicle to spin out of control. His vehicle spun between a tree
and a pole, then into a bush, which then collided with Unit#1's vehicle. Unit#1's vehicle was heavily
damaged and unable to drive. The vehicle was towed by bankers at the driver's request. The driver
claims no injuries.
SFST was conducted, which showed no sign of impairment.
It should be noted that the wet weather and the sharp turn he took, which should have been taken
slowly, could have caused him to skid and hit the sidewalk. Rain or shine, if the turn is taken without
caution, vehicles tend to skid. Most likely, this played a factor in this accident. Unit#1 stated he was
driving 15 miles per hour when he turned onto Bronson.
Unit#2's vehicle was parked at the parking lot of 1102 Bronson Way N, facing eastbound. The driver
of the vehicle was not in the vehicle at the time of the accident. However, the driver is the registered
owner's husband and has already notified the wife. The vehicle had damage to the front of the
bumper, but was still drivable.
Exchange of information with a case number was provided to both parties. Photos were taken on
scene and uploaded to evidence.
This concludes my involvement.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct. This report was electronically signed by Officer S. Tamaivena #12788,
12/01/ 2025, at 1243 hours, Renton, WA.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Light Condition: CLOUDY
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EG55426 CASE# 25-9239 DATE AND TIME 10/25/2510:08
OF COLLISION
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