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Home My WebLink About25-80150 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 CASE 25-80150 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 1 8 28 TRIBAL UNITS 04 STRUCK RESERVATION z 3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑ CowsloN 11 - 1-- 2025 1846 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 3RD ST BLOCK NO. e 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5 10 00 FEET e S ❑ W e EDMONDS AVE NE❑ 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El NO ✓ I D:2067476706 0 81 30 6❑ LAST NAME PICKETT FIRSTNAME PERRICE MIDDLE J 1 1 2 31 INITIAL STREET ❑1 23529 60TH AVE S APT H302 CITY KENT ST WA 2jP, 98032 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES No✓ I INTERLOCK YES NO✓ YES R NO 8❑ LICENSE# STATE WA SEX'M I D-MMDDYY 09 — 22 — 2000 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 1HELM USEET 2 CLASS 1 NATURE OF INJURIES z❑ 3 LICENSE CLD5233 STATE WA vN# 1C4RJEBG3HC959799 10 1❑ PI ATE� TRAILER STATE TRAILER STATE 11 3 5 PLATE# PLATE# FROM To TRLR. TRLR 3 7 33 12 3 5 VIN#j VIN# :: FROM TO ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE J 9 34 13 4 2017 JEEP GRAND SD DAMAGE YES NO ✓ YES[:] No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 4 INSURANCE CO 3 4 14 IN EF IT INSURANCE❑ NO INSURANCE N/A IN EFFECT &POLICY# 9TOP vEHla.e LECALLv res❑NO❑ CITATION# 10 BOTTOM CHARGE 36 15❑ STANDING 8 6 MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES✓ NO D:2067476707 16 a LAST NAME GUILLEN-PENALOZA FIRST NAME VICTOR MIDDLE Im INITIAL 17❑ NEW STREETREs7 154 S 152ND ST APT 2 CITY BURIEN ST WA ZIP 98148 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38 INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES t l NOF,/ 19[ DRIVER'S STATE WA SEX M D.C.B. 10 _ 02 _ 1984 39 LICENSE# MMDDYY 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HE 2 INJURY 7 NATURE OF INJURIES 40 USE CLASS NECK PAIN ❑21❑ PLATE# CTA6351 TATE WA VIN# 41 JT2BF22K310306623 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ VIN#. IN#. 43 RLR ' TOWED BY Gov HI 44 VEH YEAR 2001 MAKE TOYT MODEL CAMRY STYLE SO DAMAGE TOWED TOO✓ 24 fj YES BLIN YE S NO✓ ❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADEDAMAGEbAREA s Cd LIABILITY INSURANCE❑ INSU POLICY#E CO NO INSURANCE N/AIN STOP --E CITATION# CHARGE 25 to BOTTOM LEGALLY YES[Z N� ❑ =TURNER NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12650 WA0171300 PART A PAGE 01 OF 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG55713 COLLISION REPORT III III III III III 111 1591972 CASE# 25-80150 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) BAILEY LEENA S (I.P.ST FIRST, ADDRESS&PHONE# 3226 22ND AVE W SEATTLE WA 98199 2067346202 SEXi F MSEAT MDOYyry 11 - 02 - 2004 PASSENGER WITNESS[:] UNIT# 3 POS. 3 AIRBAG 2 RESTR. 4 EJECT ? 1 USE HELMET 2 CLASS L NATURE OF INJURIES 11 NAME '(LASTr FIRS' MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX MMDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B. MMDDYYYY. - PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. 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. JASON TURNER 11-25-25 10:15 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1 12/5/2025 8:07:34 PM BADGE OR ID# 12650 ORI# WA0171300 TIME POLICE DISPATCHED; 6:46 PM TIME POLICE ARRIVED]6:46 PM PART I PAGE IT]OF REPORT NO. EG55713 CASE# 25-80150 OF COLLISION 11/25/25 18:46 OF CbLLI510N NARRATIVE Unit 1 and Unit 3 were traveling westbound on NE 4th ST approaching Edmonds Ave NE in the number 1 lane. Unit 1 was in front of Unit 3. Unit 1 and 3 stated that they believed the light was green. Unit 2 reported that he was stopped at a redlight at NE 4th ST and Edmonds ave NE in the number 1 lane. Unit 2 reported that Unit 4 was stopped directly in front of him. Unit 2 reported that he was rear ended by Unit 1 which pushed his vehicle into Unit 4. After Unit 1 and 2 collided, Unit 3 failed to stop and rear ended Unit 1. Unit 2 reported that he did not know if Unit 2 was stopped at the light or driving forward. Directly after the collision Unit 4 drove westbound on NE 4th ST, no description of the vehicle was given by any invovled party. Unit 1 and 3 reported that they had no injuries, Unit 1 and 3 also had no notable damage to their vehicles. Unit 2 had substantial damage to the front bumper of their vehicle and the rear bumper had minor damage. Unit 2 reported that his neck had hurt from the seatbelt. Unit 2's vehicle was still in driveable condition. Unit 1 and Unit 2 had no proof of insurance. Unit 1 reported that he had insurance but it was not on his person. Unit 2 stated directly that they did not have insurance. At this time I find that the proximate cause is the failure of Unit 2 and 3 to provide enough following distance to safely stop their vehicles. I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by J. Turner 12650 on 11/25/2025 at 2050 hours. PAGE 3 OF 5 SUPPLEMENTAL REPORT No. EG55713 r`I POLICE TRAFFIC 1 0 7 27 COLLISION REPORT CASE# 25-80150 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r !CC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 1 8 28 CARRIER NAME 3 CARRIER ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GWVR NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGETHRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE tSJ CYCLE _) PEDESTRIAN � OWNER � YES NO ✓ D:2062402086 0 1 29 LAST NAME SHRESTHA FIRST NAME : MONICA MIDDLE INITIAL 0 8 30 STREET ❑ NFW AnnRFsP 609 BREMERTON PL NE CITY RENTON ST WA ZIP 98059 5 CDL IGNITIttN REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 1 2 31 INTERLOCK YEs NO✓ zERLOCK YEs❑NO f✓ vEs N ✓ DRIVER'S LICENSE STATE I WA SEX F MMDDYYv 11 - 28 - 1971 7 ON DUTY� STATUS AIRBAG' 2 RESTR. Q EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES USE CLASS 8 ❑ 1 1 2 32 LICENSE BBJ0969 TAr WA VIN# JF2SJAECXHH411239 PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 TRLR TRLR VIN.#. VIN.#. 11 3 5 VEH.YEAR2017 MAKE SUBA I MODELFORESTE STYLE SD I VEHICLE TOME E T SABLIN TOWED BY anvi vFH1C P FROM TO DAMAGE YES NO ✓ YES NO ✓ 33 REGISTERED OWNER INFOOWNED BYDRIVER 3 ] 12 3 5 SHADE IN DAMAGED AREA 3 4 FROM TO LIABILITY INSURANCE INSURANCE CO STATE FARM 4668002 E1747A q"i"Olx IN EFFECT &POLICY# 9 9 VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE 0 BOTTUM STANDING } 8 7 6 14 UNIT# 4 VEO IOCRLE O CYCLE 1:1OWNER YES AGE NOHRE3/HOLD MET PHONE ❑ 35 PEDESTRIAN 35 15 UNKNOWN OWN M'TIAL UNKN LAST NAME FIRST NAME I INITIAL 16 STREET ❑'. __ CITY RENTON ST ZIP NFW AnnRFSR CDL IGNITION REOUIREE7 IGNITION PRESENT MEDICALTANSPORTED 17 ❑ INTERLOCK YE. NO✓ INTERLOCK YES NO✓ YEs NO;./ ❑ DRIVER'S STATE SEX U D.O.B 4 37 18 ❑ LICENSE# MMDDYYY - ON DUTY STATUS AIRBAG 9 RESTR. g EJECT 1 HELMET g INJURY 0 NATURE OF INJURIES 38 USE CLASS 19 ❑ PLATE# UNKNOWN rnr Wq VIN# UNKNOWN 3 39 20 ❑ TRAILER STATE TRAILER ST 3❑ 40 PLATE#< PLATE# ATE 21 ❑ ❑ 41 TRLR TRLR VIN# YIN#i 42 22 VEH.YEAR MAKE UNKN MODEL UNKNO STYLE VEHICLE TOWED DUET SABLIN TOWED BY GOVT.VEHICLE 4 DAMAGE YES NO ✓ YES NO ✓ 23 REGISTERED OWNER INFO UNKNOWN UNKNOWN-RENTON WA 98057 SHADE IN DAMAGED AREA 43 2 3 71 LIABILITY INSURANCE INSURANCE CO IN VEHICLE EFFECT &POLICY# i OTT 44 24 LE YES NO❑ CITATION# CHARGE - iq B0TiOtvi LEGALLY E:l STANDING 8 7 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. JASON TURNER 11-25-25 10:15 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY I DATE 26 OR ID# 12650 O#II,WA0171300 CHRISTIANSEN 12/5/2025 PAGE�OF 3000-345-013(R 11118) REPORT NO. EG55713 CASE# ' 25-80150 DATE AND TIME 11/25/25 18:46 OF COLLISION i th. 3. r e 7 r At i r�r v ii 1 rr�dd k � 4 3c r ' j t� f � , PAGE 5 OF 5