HomeMy WebLinkAbout25-80458 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 25-80458 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STATE ROUTE OTHER STOLEN
❑ ❑ HFH1C;l F ❑ LOCAL AOENC 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION: 12 - 1-- 2025 1512 17 ❑. S 8 W Li OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 180TH ST BLOCK NO. e✓ 10600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 348 00 FEET e MILES S ❑ W e 108THAVESE
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:4252771887 0 4 30
6� LAST NAME MELLON FIRSTNAME RANDY MIDDLE J 1 2 31
INITIAL
STREET ❑, 11618 SE 163RD ST CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9� P1 ATE 14 CTA9567 STATE WA V N# 1 FAHP23W19G105747
TRAILER STATE TRAILE# STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. A'RLR. 1 5 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR 2009 FORD TAURUS 4D MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE 7 1 34
13 4 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 957593841 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7022454065
16 a
LAST NAME SHIELD FIRST NAME DERRICK MIDDLE IB
INITIAL
17❑ STREET ❑', 11029 SE 184TH PL CITY RENTON ST WA ZIP 98055 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCK YES❑No� INTERLOCK YEs❑NOF YES❑NOF,/
19 D IVEW # STATE WA SEX M MMDDW 05 _ 20 _ 1968 0 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY[:I] STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CJT2593 TATE WA VIN# 58AJZ1B12PU156103
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2023 MAKE LEXS MODEL ES 300 STYLE 4D —FEHICLE
TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO SAFECO H2383016IN I 5
—e E ❑ ,J� CITATION# CHARGE UR
LGALYYESN
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ROGER RANAN 13156 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG57782
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80458
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R 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.
ROGER RANAN 12-07-25 02:13 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1211112025 5:23:40 PM
BADGE OR ID# 13156 OR]# ': WA0171300 TIME POLICE DISPATCHED; 3:15 PM TIME POLICE ARRIVED',3:23 PM
PART I PAGE IT]OF 4]
REPORT NO. EG57782 CASE# 25-80458 OF COLLISION
12/06/25 15:12
OF CbLLI510N
NARRATIVE
Case 25-80458
Unless otherwise noted, all events took place in the City of Renton, in the County of King, in the State
of Washington.
This incident was captured on my body worn video camera and in-car cameras. This report is a
summary of events that occurred and is not necessarily an exact sequencing of events.
On 12/06/2025 at approximately 1517 hours, I was dispatched to a non-injury, blocking traffic collision
located on SE 180th St. Upon arrival, I observed Unit 2, with moderate damage to the front driver side
quarter panel and wheel, positioned in the eastbound lane of SE 180th St., blocking traffic. Unit 1 was
parked in the Fred Meyer parking lot just north of the roadway.
I contacted the driver of Unit 2, who identified himself as Derrick B. Shield DOB 05/20/1968 (verified
WADL). Derrick stated that he had been traveling eastbound on SE 180th St and was preparing to
turn left into the Fred Meyer parking lot. Derrick reported that prior to making a left-hand turn, Unit 1
entered SE 180th St. from the south driveway without stopping at the posted stop sign. Derrick stated
that Unit 1 subsequently collided with the front left quarter of his vehicle (Unit 2).
Based on my observations, Unit 2 was inoperable as a result of the collision, and I requested a tow
through dispatch.
Officer lurco contacted the driver of Unit 1, identified as Randy J. Mellon DOB 08/06/1960 (verified
WADL). According to Officer lurco, Randy admitted to not stopping at the posted stop sign prior to
entering SE 180th St. and acknowledged fault for the collision.
Based on the aforementioned, I determined that Randy, the driver of Unit 1, was the proximate cause
of the collision due to failing to stop at the posted stop sign before entering the roadway.
Bankers Tow arrived on scene and removed Unit 2 from the roadway. I transported Derrick to his
residence and provided both parties a case number.
This concludes my involvement with this case.
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 Officer R. Ranan #13156 12/07/2025 at 1358 hours in Hours Renton, King
County, Washington.
PAGE 3 OF 4
REPORT NO. EG57782 CASE# ' 25-80458 DATE AND TIME 12/06/25 15:12
OF COLLISION
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PAGE 4 OF 4