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HomeMy WebLinkAbout25-81134 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG64980OLCERA COLLISION REPORT 1591971 CASE# 25-81134 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE LOt`CO AGENCY 4100 3 COUNTY RD NVOLVED CODING 2❑ TOTAL 1 PRIVATE WAY TRIBAL UNITS#OF 02 SO BJECT TRUCK 1 8 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coulsfoN' 12 - 29 - 2025 1839 17 =.= S 8 W E IN OF M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION BLOCK NO. e .� 4a S 3RD ST MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 200 00 FEET e✓ S 8 W e SHATTL/CK AVE S OF 4 29 MOTtlR ✓ PEDAL- DAMAG THRESHOLD MET PHON UNIT 01 E VEHICLE CYCLE' YES NO �/ D:2064655196 30 5 LAST NAME WILLIAMS FIRST NAME MYRANDA MIDDLE C 1 2 31 INITIAL STREET E:1 6016 S 117TH PL NEW CITY, SEATTLE ST WA ZIP 981782924 2 7 CDL IGNITION REQUIRED✓ I IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCKYEs NO NTERLOCKYES NO✓ YES D NOW 8 LICIENSE# STATE WA SEX F Mpmo S Y' 02 - 04 - 1972 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY CLASS 1 NAruRE of INJURIES 2 10❑ LI ENS1tEI BFP8621 STATE WA VN# ML32F3FJ9HHF04994 3 TRAILER STATE TRAILER ..STATE 11 0 0 PLATE# PLATE# ROM TO TRLR TRLR 1 3 33 12 VIN#' VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 13 1 2017 MITS MIRAGE SD DAMAGE YES DNO ✓ YEs_ No✓ 7 3 34 REGISTERED OWNER INFO MYRANDA WILLIAMS 6016 S 117TH PL SEATTLE WA 981782924 D:2064655196 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 911762320 3 4 IN EFFECT &POLICY# 4TOP v `LE CHARGE 5 36 Lec Ly YES❑NO❑ CITATION# 7 o BOTTOM 15❑ STANDING 7 e M©TOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE UNIT ❑ ❑ PEDESTRIAN Q✓ D:3609695234 VEHICLE CYCLE' nWNFR YES✓ NO 16❑ LAST NAME NEWMAN FIRST NAME ANDREW MIDDLE' / INITIAL 17 F1 STREET �/ ❑ � 95 S TOBIN ST CITY I RENTON ST, WA ZIP 98057 4 37 NEW ADDRESS 18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38 INTERLOCKYEs No INTERLOCC YES No YES NO 19 DRIVER'S STATE WA SEXI M D.Os. 07 30 1998 39 GCENSE# MMDDYY — 4 HELMET INJURY' NATURE OF INJURIES 3 40 20❑ ON DUTY STATUS 3 AIRBAG RESTR EJECT 2 6 ❑ USE CLASS LEFT LEG PAIN AND HIP PAIN LICENSE 21 PLATE# vIN# 41 TATE 22❑ [TILER AILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. GOV H 44 VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY I 24 0 7 DAMAGE YES NO YES NO REGISTERED OWNER INFO VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# 9TOP 1-1— ❑ ,.I—I CITATION# CHARGE tO BOTTOM A Y YES N`LJ 25 s a OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 KEVIN PETERSON 12808 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EG64980 COLLISION REPORT III III III III III 111 1591972 CASE# 25-81134 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) 'NAME (LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. - [----------� MMDDYYYY PASSENGER F-1 WITNESS El UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--� POS. USE CLASS 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. - L----------� MMDDYYYY PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. - L----------� MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----j NARRATIVE I was dispatched to a vehicle collision on 12/29/25 at 200 S 3rd St Safeway, in city Renton, King County WA. Unit 1 BFP8621 Driver: Myranda C. Williams (DOB 02/04/1972) Unit 2 Pedestrian Driver: Andrew I. Newman (DOB 07/30/1998) Upon arriving I spoke to Unit 2 that told me he was walking down the North sidewalk on S 3rd St. When he went to cross the exit to Safeway parking lot Unit 1 pulling out of Safeway to Turn East on S 3rd St hit him causing him to land on the hood and then as Unit 1 pulled onto the street, he slid off the passenger side of the hood. I spoke to Unit 1 who told me as they approached the exit to Safeway parking lot, she looked to the right to see if any cars were coming. She said that the other two pedestrians had crossed and as she pulled forward to turn East on S 3rd St, she hit Unit 2. She then pulled over to the side of the road on S 3rd St. Renton Fire arrived on scene to evaluate all personal. Unit 2 was transported to the hospital with left leg pain and left hip pain. Information Exchange was given to both parties. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed: Officer Kevin L. Peterson Date and Place: 12/30/2025, 0124 hours at Renton, WA I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. KEVIN PETERSON 12-30-25 01:25 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE J.CHRISTIANSEN 10437 1/1/2026 7:33:06 PM BADGE OR ID# 12808 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 6:39 PM TIME POLICE ARRIVED 6:45 PM PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37 REPORT NO. EG64980 CASE# 25-81134 DATE AND TIME 12/29/25 18:39 OF COLLISION r t b" p r' e y n a tit .. �p } �444h )) YN y S S g 3�S� PAGE 3 OF 3