HomeMy WebLinkAbout25-80270 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG67656OLCERA
COLLISION REPORT 1591971
INTERSTATE CITY STREET FIRE I
CASE# 25-80270 2
RESULTEDSTOLENSTATE ROUTE OTHER VEHICLE LOL`CODICENC'Y 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 11 - 30 - 2025 1503 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 2ND ST BLOCK NO. e 200 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 200 00 FEET e✓ S 8 W e LAKE AVE S
2 0 29
MOTOR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:5093888924 2 0 30
5 LAST NAME KEITH FIRST NAME ZACAREY MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 901 S 72ND AVE APT 288 CITY; YAKIMA ST WA ZIP; 989081888 2
NEW ADDRESS
7 +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NOR] INTERLOCKYES NO�/ YES F ND,/
8❑ DCIENSE# STATE WA SEXI M MMDDYY' 01 — 17 — 1999 t 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
LICENSE, CFC6429 STATE WA VIN# JF2GTHRC9PH273002 3
10 Fq I as ATP tt
TRAILER
11 2 5 STATE TRAILER STATE PLATE# PLATE# ROM To
TRLR 3 7 33
12 2 5 TVINRLRRLR vIN#
FROM TO
VEH.YEAR 2O23 MAKE SUBA MODEL CROSST STYLE SV VEHICLE TOWED[n TO ZBLIN TOWED BY GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO YESII_I) NO
REGISTERED OWNER INFO ZACAREY KEITH 901 S 72ND A VE APT 288 YAKIMA WA 98908 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
1 LIABILITY INSURANCE INSURANCE CO 2 3 4
14 USAA 04444771OG
IN EFFECT &POLICY# 4TOP
VEn" CHARGE t 5 36
Lec Ly YES❑NO❑ CITATION# 70 80TTOM
15❑ STM ING s e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNRR YES�/ THR NO D:2065792069
16�
LAST NAME ANZAI FIRST NAME DARREN MIDDLE L
INITIAL
STREET ❑ 37
17 ❑ 2201 SE MAPLE VALLEY HWY APT CITY RENTON ST, WA ZIP 980570000 4
NEW ADDRESS
1$� IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCKYES NO INTERLOCK YES NO F YES ND�
19 DRIVER'S STATE WA SEX M D.O.e. 02 25 1985 39
LICENSE# MMDRYY —
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 R USE 2 CLASSY 1 NATURE OF INJURIES 40
21 LICENSE CSG9862 rare WA vIN# JTEABFAJXSK039982 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2025 MAKE TOYT MODEL LAND STYLE qp VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO DARREN ANZAI 2205 MAPLE VALLEY HWY APT 606 RENTONWA98057 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 999505474
IN EFFECT &POLICY# 9TOP
ve w1— ❑ ,J—I CITATION11 CHARGE t080TTOM
L','—�Y YES N
25 a e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
RAYMOND WATSON 13127 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EG67656
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80270
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 GLASS 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.
RAYMOND WATSON 01-04-26 07:41 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
J.TRADER 4553 1 111012026 2:02:30 PM
BADGE OR ID# 13127 ORI# WA0171300 TIME POLICE DISPATCHED 1 3:04 PM TIME POLICE ARRIVED i 3:08 PM
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EG67656 CASE# 25-80270 O OF COLLI 510N TIME 11/30/25 15:03
COLLISION
NARRATIVE
25-80270
This report is a summary of events that occurred and is not an exact sequencing of events.
Statements have been paraphrased and summarized.
On 11/30/2025 at approximately 1504 hours, myself, Officer R. Watson, was dispatched to an
accident with no injuries non-blocking, at the intersection of S 2nd ST and Lake AVE S, within the City
Limits of Renton, County of King, State of Washington.
Dispatch notes stated that the vehicles were in the Safeway parking lot, no injuries and non-blocking.
When I arrived on scene, I saw two vehicles parked in the Safeway parking lot with the drivers
standing outside of them.
Unit#1 driven by Zacarey R. Keith (DOB 01/17/1999) verified by WA DOL photo, was driving a Gray
2023 Subaru Crosstrek, WA plate CFC6429. His spouse was also a passenger in the vehicle, but she
did not identify herself. Zacarey said that he was traveling westbound on S 2nd ST in the number 3
lane when unit#2 pulled into his lane colliding with him. Zacarey said that neither him or his
passenger were injured and declined aid. When I asked for Zacarey's license, registration and
insurance he was able to provide me with all documents. Unit #1 had moderate damage to the left
side side of the vehicle, no airbag deployment and was able to be driven from the scene.
Unit#2 driven by Darren L. Anzai (DOB 02/25/1985) verified by WA DOL photo, was driving a Blue
2025 Toyota Land Cruiser, WA plate CSG9862. There were no other occupants in the vehicle. Darren
stated that he was traveling westbound on S 2nd ST when unit #1 turned into his lane. Darren said he
was not injured and declined aid. Unit#2 had minor front end damage, no airbag deployment and
was able to be driven from the scene.
An exchange of information was completed and provided to each party.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer R. Watson #13127 01/04/2025 0734 hours, Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EG67656 CASE# 25-80270 DATE AND TIME 11/30/25 15:03
OF COLLISION
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