HomeMy WebLinkAbout25-80873 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG61124oc� RA
COLLISION REPORT 1591971
CASE# 25-80873 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOL`CODICENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT o 5 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s o v' 12 - 19 - 2025 1757 17 =.[� S 8 W e OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 180TH ST BLOCK NO. e 8800 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET B S B W e
0 3 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2065927009 0 4 30
5 LAST NAME MITCHELL FIRST NAME KEYVON MIDDLE I 1 2 31
INITIAL
STREET ❑ 2520 S 234TH ST CITY; DES MOINES ST I WA ZIP 98198 2
NEW ADDRESS
7 +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO✓ INTERLOCKVES No✓ YES F No;✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 07 — 20 — 1998 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 CLASSY',1 [NATURE of INJURIES 2
LICENSE, CEW5241 STATE WA VIN# 3FA6POH9XFR145568 3
10 Fq I as ATP tt
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR TRLR. 7 1 5 33
12 3 5 VIN# vIN#
FROM TO
VEH.YEAR 2015 MAKE FORD MODEL FUSION STYLE SD VEHICLE TOWED TO BLIN TOWED By GOVT VEHICLE 3 5 34
13� DAMAGE YES�NO ✓� YES NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
a LIABILITY INSURANCE INSURANCE CO 4
14 ALLSTATE 942502483
IN EFFECT &POLICY# 9TOP
11
vEn ' CHARGE t 5 36
IALLr yes❑NO❑ CITATION# t a 80TTOM
15❑ STANDING s 7 e
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:4255246714
16�
LAST NAME DHANOA FIRST NAME HARLEEN MIDDLE K
INITIAL
17 F1 STREET ❑
'❑ 11007 SE 196TH ST CITY' KENT ST, WA ZIP 98031 37
NEW ADDRESS
1$❑ CDL IGNITION RE(2UIRED IGNI I ION PRESENT MEDICAL TRANSPORTED 38
INTERLOCKves No✓ jNTERLOCKYEs NO✓ YEs No'✓
19 DRIVE #
NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 4 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 PATE# BWL1642 rare WA vIN# JHLRW2H83KX004262 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2019 MAKE HOND MODEL CR-V EX STYLE $V VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO BHUPINDER DHANOA 11007 SE 196TH ST KENT WA 98031 D:4255246714 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
LIABILITY INSURANCE INSURANCE CO SAFECO F4073425
IN EFFECT &POLICY# 9TOP
V—L ,J—I CITATION# CHARGE to BOTTOM
LEGALLY YES❑ N`[
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
NICHOLAS SWAN 12965 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG61124
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80873
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 INJURY 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 0,SS ----�
: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
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 12-20-25 05:25 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
QUINT TIBEAU 7691 1212012025 10:31:21 PM
BADGE OR ID# 12965 ORI# WA0171300 TIME POLICE DISPATCHED 1 6:18 PM TIME POLICE ARRIVED i 6:35 PM
PAST B a Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG61124 CASE# 25-80873 DATE OF COLLI r�510NN + 12/19/25 17:57
L1
NARRATIVE
#25-80873
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 12/19/2025 at approximately 1818 hours I was dispatched to a non injury, non blocking accident
with in the 8800 block of S 180th St in the city of Renton, King County, WA.
Unit#1 was a black 2019 Honda CR-V with WA LIC BOL1642 (VIN: JHLRW2H83KX004262). 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 white 2015 Ford Fusion WA LIC: CEW5241 (VIN: 3FA6POH9XFR145568). 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, dark, and overcast at the time the collision occurred. Both vehicles
were able to move off the roadway under their own power. Unit#1 did require a tow truck for a side
air bag deployment on the passenger side of the vehicle. Gene Meyer Towing was dispatched for the
driver.
Driver#1 of Unit#1 stated he was traveling east bound on S 180th St and had merged into a right
hand turn lane that opens up just west of Starbucks located at 8825 S 180th St. He was going to
make a right hand turn into Starbucks. He stated that traffic in lanes 2 and 3 was stopped. As he
approached the driveway to Starbucks, Unit#2 was turning into the same driveway and the two
vehicles collided.
Driver#2 of Unit#2 stated she was driving west bound on S 180th St and was going to turn south into
the parking lot where Starbucks is located. She stated traffic in lanes 2 and 3 was stopped, and that
both drivers had allowed her time and space to turn south into the parking lot. As she crossed lane 2
into lane 1 (curb turn lane) she was struck on the passenger side rear door by Unit#1.
Pictures of the collision were uploaded to Axon from my department issued cell phone.
Both drivers had valid insurance and an exchange of information was provided to each of them.
At the conclusion of my investigation, I determined that Unit#2 was the proximate cause of the
collision as all 3 lanes of traffic were not clear for her to turn.
If Unit#1 would have ensured that lane 1 was also clear before proceeding with her turn then this
collision would not have occurred.
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 12/12/2025 at 1908 hours, in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. EG61124 CASE# 25-80873 DATE AND TIME 12/19/25 17:57
OF COLLISION
4, 3
�t {
,rjsx
e�
I.
� r
i
its �
� s sib
G
{ 4
ti
Y
p
i'
i
SS
7
ti
PAGE 4 OF 4