HomeMy WebLinkAbout25-80836 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EG69109OLCERA
COLLISION REPORT 1591971
ASE# 25-80836 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`GENC'Y. 4200 3
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ 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
COLL.ISION'. 12 - 18 - 2025 1322 17 =.= S 8 W E IN OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
N 4TH ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 C------�.� FEET H S 8 W e PARKAVEN
0 1 29
MOTtlR PEDAL- DAMAG THRESHOLD MET PHON
UNIT 01 E
VEHICLE ❑ CYCLE' ❑ YES NO �/ D:2092149813 0 9 30
6 LAST NAME SMITH FIRST NAME JAMAHL MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 3723 S 180TH ST APT B103 CITY SEATAC ST; WA ZIP 981884572 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYES NO INTERLOCKYEs N YES F NO
8� LICIENS# STATE WA SEx M MMOCSYY' 04 - 27 - 2002 1 2 32
9[�] ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY
CLASS 1 NAruRE of INJURIES 2
LICENSE, C01779C STATE WA VN# 54DC4W1B3HS800565 3
10 as ATP rt
TRAILER STATE TRAILER ,STATE
11 3 0 PLATE# PLATE# ROM TO
TRLR TRL.R 5 1 33
1 0
FROM TO
2 Q VIN# VIN#
VEH.YEAR 2017 MAKE ISU MODEL NPR STYLE VEHICLE TOWED TO NO
TOWED By GOVT VEHICLE 9 9 34
13 2 DAMAGE YES�NO� YES❑ NO
REGISTERED OWNER INFO EDGE CONSTRUCTION SUPPL Y INC PO BOX 3437 SPOKANE WA 99220 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14� LIABILITY INSURANCE NSURANCECO GREATAMERICANASSURCAPF05262702
IN EFFECT &POLICY#VEHICLE
4TOP _
srgNOLNG ❑ CITATION# 5A0900804 CHARGE INATTENTIVE DRIVING B o ooTrofi 36
Yes NO
15
III MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:4253269776
16�
LAST NAME SUAZO RAMIREZ FIRST NAME SHARON MIDDLE I Y
INITIAL
STREET ❑ 37
17 '❑ 40361 ST NE CITY AUBURN ST, Wq ZIP 980021358
NEW ADDRESS
1 g❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' ❑ 38
INTERLOCKYEs ND (NTERLO'K YES NOF vEs NDI
19 DRIVER'S STATE WA SEY F D.O.B. 05 23 1997 39
LICENSE# MMDDYY —
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICEN LATE� CUU8992 rarE WA vIN# 1GNKVGKD6HJ172517 41
22❑ [TILER AILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
VEH.YEAR 2017 MAKE CHEV MODEL TRAVERS STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO SHARONSUAZO RAMIREZ 40361 ST NE AUBURN WA 980021358 D:4253269776 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 864061416
IN EFFECT &POLICY# t 9TOP
veeiae ,J—I CITATION# CHARGE tO BOTTOM
LecnLLY YES N`[
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
POLIICFETRAFFICN CORRECTION REPORT NO. EG69109
COLLISION REPORT III III III III III 111
1591972 CASE# 25-80836
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#
S ' D.O
EX .B.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----------�
MMDDYYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
❑ Q POS. USE CLASS �____ ----j
NARRATIVE
s1v/2 lane two for It wht/1 truck rear
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle crash occuring at the intersection
of Park Ave N at N 4th St.
I contacted the driver of unit 2 who told me she was northbound lane 2 and waiting to a make a left
turn onto N 4th St when she was nit in the back by unit 1. She did not complain of injury and
damages did not require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL. He told me he was northbound lane 2. He
told me he did not notice unit 2 was not when he changed lanes and was unable to stop in time to
avoid contacting the back of unit 2. He did not complain on injury and damages did not require a tow
truck.
I cited unit 1 ref RMC 10-12-25 Driver inattention 2 vehicle crash via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 12/23/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 12-23-25 04:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
1/15/2026 1:48:03 PM
C.JACOBS 1953
BADGE OR ID# 2517 ORI# ( WA0171300 TIME POLICE DISPATCHED; 1:22 Pry TIME POLICE ARRIVED 1:34 PM
PART B 3aaa-345-,aa(R11Y1s) PAGE 27OF 37
REPORT NO. EG69109 CASE# 25-80836 DATE AND TIME 12/18/25 13:22
OF COLLISION
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