HomeMy WebLinkAbout25-80614 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-80614 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F E: LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
5
RESERVATION 1
TRIBAL UNITS 02 STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 12 - 11 - 2025 1958 17 �. S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
TALBOT RD S BLOCK NO. e✓ 17700 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e S 177TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4254437864 0 4 30
6� LAST NAME DURANT FIRSTNAME RANDALL MIDDLE M 1 2 31
INITIAL
STREET ❑ 1022 S 31ST CT C{TY RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs 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❑ PI ATE 1 WAZZU sTATI WAurN# 1 NXBR30E95Z553592
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. YRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 1 34
13❑$ ZOOS TOYT COROL SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 2834542FO147J 3 4
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2064597631
16 a
LAST NAME GONZALEZ FIRST NAME MARIA MIDDLE B
INITIAL
17❑ STREET ❑', 5412 32ND AVE S CITY SEATTLE ST WA ZIP 98118 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YES❑No� INTERLOCK YEs I I NOF YES
t l NO
�
19 LICENSE# STATE WA SEX F MMDDW 08 _ 04 1961 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE AOL8827 TATe I WA VIN1t JN8AS5MVXDW663648
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GoI
VEH YEAR 2013 MAKE jyl$$ MODEL ROGUE STYLE $V —FEHICLE
TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 0395417FO747FIN IULlliKOTlTlfll;0-
NAME--E ❑ ,J� CITATION# CHARGEYESN`L J25 =AS
(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. EG57934
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80614
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
POS. USE CLASS
NAME
'(LAST,FIRS 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.
NICHOLAS SWAN 12-12-25 12:36 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1 121IV2025 3:20:46 AM
BADGE OR ID# ( 12965 OR]# WA0171300 TIME POLICE DISPATCHED', 7:88 Pry TIME POLICE ARRIVED',8:06 PM
FART I PAGE IT]OF 4�
REPORT NO. EG57934 CASE# 25-80614 OF COLLISION
12/11/25 19:58
OF CbLLI510N
NARRATIVE
#25-80614
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 1958 hours I was dispatched to a non injury, non blocking accident
with in the 17700 block of Talbot Rd S in the city of Renton, King County, WA.
Unit#1 was a silver 2005 Toyota Corolla with WA LIC 1 WAZZU (VIN: 1 NXBR30E95Z553592). 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 black 2013 Nissan Rogue with WA LIC AOL8827 (VIN: JN8AS5MVXDW663648). The
driver of Unit#2 was the sole occupant and was wearing their seatbelt at the time of the accident.
They did not require medical attention.
Roadway conditions were wet and dark with light rain at the time the collision occurred. Both vehicles
were able to move off the roadway under their own power and did not require a tow truck.
Driver#1 of Unit#1 stated he was traveling north bound on Talbot Rd S and passing through the S
177th St intersection with a green light. As he passed through the intersection, he said he was hit in
the rear driver side passenger door by Unit#2. This caused damage to his vehicle door and rear
wheel well.
Driver#2 of Unit#2 stated she was driving east bound out of the Valley Medical Center parking lot at
the intersection of S 177th St and Talbot Rd S. She stated she had a green light to make her left hand
turn on to Talbot Rd S. When she made her turn, she said Unit#1 moved through the intersection and
the two collided with her front passenger side bumper.
Pictures of the collision were uploaded to Axon from my department issued cell phone.
At the conclusion of my investigation, I was unable to determine proximate cause of the collision.
Both drivers believed they had a green light giving them the right of way to the intersection.
If both driver#1 and driver#2 looked both ways before entering the intersection to ensure no
oncoming traffic was approaching, then 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. EG57934 CASE# ' 25-80614 DATE AND TIME 12/11/25 19:58
OF COLLISION
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