HomeMy WebLinkAbout25-80505 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 25-80505 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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 CITY# ❑
COLLISION.. 12 - 08 - 2025 1253 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SUNSET BLVD NE BLOCK NO. e✓
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 30 00 FMILES EET e S B W e HWY 405 NON RAMP
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2065136685 0 7 30
6� LAST NAME STELIVAN FIRSTNAME CYNTA-LIYAH MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 13018 101 ST LN NE,APT 3 CITy KIRKLAND ST WA 2jp, 98034 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 1/ I NO NTERLOCKYEs NO Z/ YES R No�/
8❑ L CIENSE# STATE yyq SEXI F MM D Y' 12 - 21 - 2003 1 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 1HELM
USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
10 3] PI ATE 14 A8911989 STATE WA V N# 1 FAFP34N75W251038
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# IR.. ro
TRLR. YRLR. 5 1 33
12 2 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE J 9 34
13 3 2005 FORD FOCUS SD DAMAGE vEs 0NO agW�MEYER ves❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 866663158 4
IN EFFECT &POLICY# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UN�T VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YEs NO 1/ D:4254448541
16 a
LAST NAME OLSON FIRST NAME KYRA MIDDLE M
INITIAL
17 STREET❑ NEW ADDREss❑' 2170 155TH LN SE CITY BELLEVUE ST WA ZIP 980075084 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK vEs It I NOF YES
t l NOF,/
19 LDIIVERS STATE WA ]SEX IF MMDDW 04 22 _ 1967 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# LH04883 TATE 41
WA VIN1 JF2GUADCXRH875051 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2024 MAKE S(JB�Q MODEL CRO$S7' STYLE GA DAMAGE TOWED NOO✓ BLIN TOWED By ov HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO PEMPCO CA0634618IN 1GQVEHICLE
CITATION# CHARGE
LEGALLY YES[Z NCE
25❑ JAGENCY
s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID#
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG58049
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80505
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,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'
RTF
On 12-08-2025 at about 1235 hours, I was sent to a collision which occurred at Sunset Blvd NE and
Hwy 405 north onramp, with in the City of Renton, King County, Washington.
Upon arrival both drivers were unhurt and identified via a DOL photos.
The driver of unit 2 said she was stopped in traffic waiting to get onto the onramp.
Driver of unit 1 said she wasn't able to stop in time and collided with unit 1. She elaborated the there
was a curve in the road and did not see the other vehicle in time to stop.
Unit 1 had to be towed away from the scene.
Both drivers had called in the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 12-08-25 03:40 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 12/12/2025 9:43:35 AM
BADGE OR ID# 10065 OR]#' WA0171300 TIME POLICE DISPATCHED; 12:53 PM TIME POLICE ARRIVED',12:59 PM
PART I PAGE IT]OF 3�
REPORT NO. EG58049 CASE# ' 25-80505 DATE AND TIME 12/08/25 12:53
OF COLLISION
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