HomeMy WebLinkAbout25-80610 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 25-80610 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 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# ❑
cawsloN 12 - 11 - 2025 1748 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE CARR RD BLOCK NO. e✓ 10300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 300 00 FEET e S ❑ W e 103RD AVE SE❑
0 6 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:2067716498 0 7 30
6� LAST NAME KAUR FIRSTNAME JATINDER MIDDLE 1 2 31
INITIAL
STREET ❑, 4600 DAVIS AVE S APT K101 CITY RENTON ST WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CPY0835 sTArI WAvIN# 1 NXBR30E76Z627951
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR 2008 TOYT COROL SD MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 DAMAGE YESNo YES❑ NO
REGISTERED OWNER INFO HARI.EEPSINGH 4100 DAVIS AVE S APT K101 RENTON WA 98055 D:2067716498 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO SAFEGUARD 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO 1/ D:4254654538
16 a
LAST NAME FERTINO FIRST NAME JOSE MIDDLE D
INITIAL
17 STREET❑ NEW ADOREss❑' 19210 121ST PL SE CITY KENT ST WA ZIP ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 DIVER #
{NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I CDL6172 TAre WA vIN# 1FAHP3F25CL131457
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2012 MAKE FORD MODEL FOCUS STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JOSE FERTINO 19210121STPL SE KENT WA D:4254654538 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO PROGRESSIVE 924498615IN I GD
—ILLE CITATION# CHARGE
25
LEGALLY YES[Z Nu
❑ s a
=AS
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 SWAN 7 12965 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG57862
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80610
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DIAZ GONZALEZ MARINA
(IAST FIRST,
ADDRESS&PHONE# D O.B.
19210 121ST PL SE KENT WA SEX F MMDDYyry 04 - 08 - 1972
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
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.
NICHOLAS SWAN 12-11-25 07:23 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 1211112025 10:27:43 PM
BADGE OR ID# ( 12965 OR]# WA0171300 TIME POLICE DISPATCHED'; 5:48 PM TIME POLICE ARRIVED 5:48 PM
FART I PAGE IT]OF 4�
REPORT NO. EG57862 CASE# 25-80610 OF COLLISION
12/11/25 17:48
OF CbLLI510N
NARRATIVE
#25-80610
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 an exact sequencing of events.
On 12/11/2025 at approximately 1748 hours I was dispatched to a blocking accident with unknown
injuries in the 10300 block of SE Carr Rd in the city of Renton, King County, WA. The accident was
on-viewed by Renton Fire vehicle A-313.
Unit#1 was a grey 2008 Toyota Corolla with WA LIC CPY0835 (VIN: 1 NXBR30E76Z627951). The
driver of unit 1 was the sole occupant and was wearing their seatbelt at the time of the accident. They
did not require medical attention.
Unit#2 was a red 2012 Ford Focus with WA LIC CDL6172 (VIN: 1 FAHP3F25CL131457). The driver
of Unit#2 was wearing his seatbelt at the time of the accident. Unit#2 had a passenger in the front
seat at the time who was also wearing their seatbelt.
Roadway conditions were wet and dark with light rain at the time the collision occurred.
I arrived on scene where Renton Fire was already on scene checking the occupants of each vehicle
out. All occupants were medically cleared. Both vehicles were blocking lane 1 westbound on SE Carr
Rd.
Driver#1 of Unit#1 stated she was driving westbound when vehicles in front of her started to stop
due to a collision that took place further up the road. As she hit her breaks and proceeded to stop,
she stated her car slid, causing her to hit the vehicle in front of her with her front bumper, causing
damage to her car.
Driver#2 of Unit#2 stated he was driving west bound on SE Carr Rd when traffic in front of him came
to a stop. As he was stopped, the vehicle behind him hit him in the rear.
Both vehicles were able to move off the roadway under their own power and did not require a tow
truck.
Pictures of the collision were uploaded to Axon from my department issued cell phone.
Driver#1 did not have her insurance card on her at the time of the collision. She stated she would
text a picture to Driver#2 when she got home.
At the conclusion of my investigation, I determined that the proximate cause of the collision is due to
Unit 1 not providing enough space in front of them for an emergency braking situation. By not
providing enough room, she had to hit her brakes hard on a wet road that caused her to skid and
collide with the car in front of her.
If driver#1 would have left themselves enough room for emergency braking this collision would not
have happened.
This concludes my report.
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 N. Swan on 12/11/2025 at 1835 hours, in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. EG57862 CASE# ' 25-80610 DATE AND TIME 12/11/25 17:48
OF COLLISION
Zj
£
xr i
2r
f,
1{
�It
k
a t
1 4 A
1
7�
°r3 I f
at
PAGE 4 OF 4