HomeMy WebLinkAbout25-80655 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG59422OLCERA
COLLISION REPORT 1591971
CASE�# 25-80655 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL ANG 4200 3
COUNTY RD INVOLVED
CODING
PRIVATE WAY
2❑ TRIBAL TOTAL 1
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
coulslON' 12 - 12 - 2025 2329 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION NON INTERSECTION ❑
N 3RD ST BLOCK NO.
4a❑
MILE POST e
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e SUNSET BLVD N
0 4 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES No F/ D:2064235509 0 4 30
6 LAST NAME HARRIS FIRST NAME CLYDE MIDDLE 1 1 2 31
INITIAL
STREET ❑ PO BOX 88613 CITY TUKWILA ST WA ZIP 98138 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NOR INTERLOCK YES NO YES D NO
8❑ LICIENS# STATE WA SEX M MMor YY' O6 — 23 — 1960 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET 2 1 INJURY
CLASS 1 NAruRE of INJURIES 2
10 1❑ aiCENSE' D50425C STATE WA VN# 1D7HU18Z33S206962 3�
TRAILER STATE TRAILER ,STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR TRLR 7 1 33
1 3
FROM TO
2 Q VIN# VIN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE
13 2 2003 DODG RAM DAMAGE YES NO ✓ YEs❑ No 7 1 34
REGISTERED OWNER INFO CLYDE HARRIS 1062522ND PL S APT 101 SEATTLE WA 98168 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 11 4TOP _
srgNOLNG Yes NO❑ 5A0517403 CHARGE OP MOT VEH W/OUT INSURANCE B o ooTrob 36
CITATION#
15
III MOTCYR PEDAL- PEDESTRIAN PROPERTY fl DAM THR OLD MET PHONE
UNIT O2 VEHICLE CYCLE nWNFR YES NO ,/ D:2066017699
16�
LAST NAME NAMATAME FIRST NAME MICHELLE MIDDLE C
INITIAL
17 F1 STREET ❑❑ 12848 SE 161ST ST CITY RENTON ST, WA ZIP 37
980585323
NEW ADDRESS
18❑ CDL IGNITION REQUIREC3 (GNTION PRESENT MEDICALTRANSPORTED: 38
INTERLOCKYEs NO INTERLOCKYEs N.Fj YES NO
19 DRIVER'S STATE WA SEXI F D.O.B. 09 09 1981 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS 1 ❑
21 LICENSLATE E CPX8254 TATE WA VIN# 2T2HK31 UX7C018467 41
22❑ PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2QQ7 MAKE LEXS MODEL RX STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO MICHELLENAMATAME12848SE161STST RENTONWA98058 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 70183005
IN EFFECT &POLICY# t 9TOP
LEIAIL ❑ CO CITATION# CHARGE tO BOTTOM
VEHICLE YES NCO
s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
K.LANE 10008 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG59422
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80655
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX' D.O.B. - [----------�
MMDDVVYY
PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--�
POS. USE CLASS
'NAME
(LAST FIRS,MIDDLE INITIAL)
ADDRESS&PHONE#
' D.O.B.
SEX MMDD —F L----------�
YYYY
EAT HELMETNJURY URE OF
PASSENGER ❑WITNESS UNIT# S AIRBAG RESTR. EJECT NAT INJURIESPOS. : USE CLASS ----�
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. - L----------�
MMDDVVYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
Unit 1 was on eastbound N 3rd ST at a red light at Sunset BLVD N, in the far left, left turn only lane
planning to turn left onto northbound Sunset BLVD N. Unit 2 was in the lane directly to the right
(south) of Unit 1, also on eastbound N 3rd ST intending to turn left onto northbound Sunset BLVD N.
When the light turned green and both Units began their left turns, Unit 1 did not turn left into the
nearest lane and drifted wide into the lane Unit 2 occupied with the right of way. The front passenger
side of Unit 1 struck the rear driver's side of Unit 2 causing minor damage to both vehicles.
Driver 1 advised he did not have insurance.
The proximate cause of this collision was the fact Driver 1 did not turn into the nearest lane as
required by law, drifted wide, and impacted Unit 2.
Driver 1 cited for operating a motor vehicle without insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
K.LANE 12-13-25 12:14 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 12/16/2025 12:58:07 PM
BADGE OR ID# 10008 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 11:31 PM TIME POLICE ARRIVED 11:34 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG59422 CASE# 25-80655 DATE AND TIME 12/12/25 23:29
OF COLLISION
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