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HomeMy WebLinkAbout25-81030 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG62819oc� RA COLLISION REPORT 1591971 CASE# 25-81030 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STATE ROUTE OTHER STOLEN ❑ ❑ VEHICLE ❑ LOCALANG 3 HIT&RUN C©DIN6 COUNTY RD PRIVATE WAY INVOLVED 2 TOTAL#OF OBJECT 1 s 28 TRIBAL UNITS 03 STRUCK RESERVATION : 1 1 2 3I M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# eDCLson' 12 - 25 - 2025 1625 17 =.= S 8 W e IN e 1070 s 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 7TH ST BLOCK NO. e 3400 .� 4a❑ MILE POST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 150 00 FEET e✓ e OLYMPIA AVE NE S 8 W OF11 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4254424972 1 4 30 6❑ LAST NAME LEW FIRST NAME CAMERON MIDDLE E 1 2 31 INITIAL STREET ❑ 716 PIERCE AVE NE CITY; RENTON ST I WA ZIP 98056 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO✓ I INTERLOCKVEs NO✓ YES D NO✓ 8 DCIENSE# STATE WA SEXI M MMDDYY' 01 - 25 - 1996 32 -NJUR 9 ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 HELMET USE 2 CLA SY'1 [NATURE of INJURES 2 10 LI CEN5E'' BIU2632 STATE WA VIN# YV1612FS2D2231000 3 TRAILER STATE TRAILER STATE 11 0 0 PLATE# PLATE# FROM To TRLR TRLR 7 1 3 33 12 0 0 VIN#' VIN# FROM TO 13 VEH.YEAR2013 MAKE VOLV MODEL S60 STYLE SO VEHICLETOWEDONO�iS46LIN T�VyED.6LRS GOVT IEHI m 34 DAMAGE IIII._IIII HHttVVii((tt I�_I REGISTERED OWNER INFO CHRISTINE LEW 716 PIERCE AVE NE RENTON WA 98056 VEHICLE NO. 1 2 SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE[ NSURANCE CO AMERICAN FAMILY 192321170272FPPAWA IN EFFECT &POLCY#V""' CHARGE 36 LEGALLY YES❑NO❑ CITATION# <14, 15 STANDING UN# MOTOR PEDAL- E] PEDESTRIAN1:1 PROPERTY DAM THR OLD MET PHONE 1 VEHiC1.E CYCLE nWNFR YES�/ NO 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE' INITIAL 17❑ STREET ❑ CITY ST ZIP 4❑ 37 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED: 38 INTERLOCKYEs NO INTERLOCK YES R NoF vEs NQ 19 DRIVER'S # STATE SEX U MMDCSYY -� 39 HELMET INJURY: NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 1 USE 9 CLASS 0 ❑ 21 LICEN#LATE ICCH6871 rare WA vIN# JTMFB3FV4ND078712 41 22❑ PLATE# STATE[TILER I PLATE# STATE 42 23 TRLR RLR 43 UIN#. 'IN# VEH.YEAR 2022 MAKE TOYT MODEL RAV4 STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO VES NO✓ REGISTERED OWNER INFO KODLEEYIN363681STAVESE MERCER ISLAND WA 98040 VEHICLE NO.2 SHADE IN DAMAGE,5AREA 2 3 �4 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 956087947 IN EFFECT &POLICY# t STOP LVEHICLE '—LY YES❑ N CL] CITATION# CHARGE to BOTTOM LEGALL 25 a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 E.EDMUNDS 12576 WA0171300 PAGE 01 OF PART A 3000-345-189(R 11/18) STATE OF POLICETRAFFICN CORRECTION REPORT NO. EG62819 COLLISION REPORT III III III III III 111 1591972 CASE# 25-81030 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. — MMDDYYYY PASSENGERQ WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ; HELMET NJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CIASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. I USE CLASS NARRATIVE Unit 2 and Unit 3 were unoccuipied and legally parked on the street in front of 3414 NE 7th ST. Unit 1 was traveling eastbound on NE 7th St between Newport CT NE and Olympia CT NE. Unit 1 veered right, colliding with Unit 2 which was pushed into Unit 3. Unit 1 and Unit had extensive damage, rendering them both unable to operate. Unit 3 had damage to the rear end. All three appeared to have damge greater than $1000. Driver 1 stated he was fatigued following a large meal and dozed off as he was driving home. He lost control of the vehicle and struck Unit 2. Driver 1 provided a WA driver's license, vehicle registration and proof of insurance. Driver 1 declined medical evaluation at the scene. The registered owners of Unit 2 and Unit 3 provided contact and insurance information. Driver 1 was fatigued and lost control of his vehicle which was the proximate cause of the collision. 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 E. Edmunds #12576 at 1823 on 12/25/2025 in Renton, WA. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. E.EDMUNDS 12-25-25 06:29 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE M.BRAUN 2194 12/26/2025 12:16:24 AM BADGE OR ID# 12576 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:25 PM TIME POLICE ARRIVED i 4:25 PM PAST B 3 Da-3mx—attar(txIMR) PAGE 2�OF 47 SUPPLEMENTAL REPORT No. EG6281 9 POLICE TRAFFIC 1 1 8 27 µ ^'� COLLISION REPORT CASE# 25-81030 t113197 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE UNIT# USDOT ICC# VEHICLE TYPE CARGO BODY: TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS CITY ST ZIP 4 ❑ NAME # PLACARD AME I GWVR NF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS { MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT�T 3 VEHICLE CYCLE C) PEDESTRIAN :.. OWNER YES NO 1 4 29 LAST NAME UNKNOWN FIRST NAME MIDDLE'. INITIAL STREET 30 NEW ADDRFSJ—jl CITY ST ZIP 6 PRESENT MEDICALTANSPORTED. 1 31 CDL IGNITION RESOUIRE6 1{iNi7ION INTERLOCK YES NOINTERLOCK YES NO I YES N DRIVER'S STATE I SEX U MMD DYW L LICENSE 7 ON DUTY STATUS AIRBAG 9 RESTR. 9 EJECT 9 HELMET 9 INJURY 0 NATURE DF INJURIES USE CLASS 8 ❑ 1 32 LICENSE CAM8621 TAT WA VIN JM3KFBDM2M1440714 PLATE# 9 TRAILER TRAILER L PLATE# STATE PLATE STATE 0 10 ❑ TRLR TRLR VIN.# VIN#. 11 0 0 VEH.YEAR2021 MAKE MAZD MODELCX 5 STYLE UT VEHICLE TOWE E T ABLIN TOWED BY GovT.vEHICI E FROM TO DAMAGE YES NO ✓ YES NO REGISTERED OWNER INFOM SHADE IN DAMAGED AREA AYA RAJAN 2226 205TH PL SW LYNNWOOD WA 98036 m 33 12 � FROM TO LIABILITY INSURANCE❑ INSURANCE CO 7t)P IN EFFECT &POLICY# 1 '""-'" m 34 13 vewc�e YES NO CITATION# CHARGE 1080TTOM ecauv sTnNoiNc 3 7 MOTOR PEDAL_ ' 1:1PROPERTYDAMAGE THRESHOLD MET PHONE 35 14 ❑ UNIT# VEHICLE CYCLE PEDESTRIAN OWNER YES NO 36 15 LAST NAME FIRST NAME INITIAL 16 ❑ STREET �' CITY ST ZIP NEW ADDRESa CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED INTERLOCK YES NO INTERLOCK YES NO :YES NO 17 5 37 LDICENSE# STATE SE 18 X M ❑ HELMET 'INJURY: NATURE OF INJURIES 38 ON DUTY STATUS AIRBAG RESTR. EJECT USE CLASS.: 19 ❑ ❑ 39 PLATE# LICENSE TAT AN# 20 TRAILER' TRAILER 40 PLATE#, STATE STATE PLATE# - ❑ 21 ❑ [4 41 VIN# 42 TRLR TRLR UIN#:' 22 VEH.YEAR MAKE I MODEL I STYLE I VEHICLE TOWED DUET ABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO. SHADE IN DAMAC ED AREA 43 2 3 4 LIABILITY INSURANCE INSURANCE CO IN EFFECT I &POLICY# 7c;Q S. 44 vewc�e ❑ ❑ CITATION# CHARGE 24 I..EGALLY YES NO STIWDING 8 3 G 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. E.EDMUNDS 12-25-25 06:29 PM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED 26 BADGE 1 OR ID# 12576 O#RI WA0171300 APPROVED BY 12126/202 PAGE OF 3000-345-013(R 11/18) REPORT NO. EG62819 CASE# 25-81030 DATE AND TIME 12/25/2516:25 OF COLLISION nl, c x. fv. s 4 Y , Y ;toy c t i x �t \a�q) 3es ti s soS� t PAGE 4 OF 4