HomeMy WebLinkAbout26-4729 TFFiNouCERA II I III 1 III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 2s-4ns 2
INTERSTATE ❑ CITY STREET FIRE F RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 ❑2$
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GawsloN 06 - 1-- 2026 1419 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
TALBOT RD S MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e S 21ST ST
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065183318 30
6� INITIAL
LAST NAME KIM FIRSTNAME CHANGE MIDDLE M 1 1 2 31
STREET ❑, 1117 S 23RD ST CITY RENTON ST WA ZIP' 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'F MID
.O B 09 - 09 - 1955 32
INJURY —, [NATURE OF INJURIES
9 ON DUTY❑ STATUS' AIRBAG 9 RESTR 4 EJECT 1 H U SE CLASS 7 I COMPLAINT OF PAIN z❑
3
10❑ Pi ATNES# BTF2787 sTAr WAv N# 3GSCL93209S631117
IT STATE TRAILER STATE
11 3 0 PLATE# I PLATE# I I FROM TO
TRLR. YRLR. 5 1 33
12❑ vIN#' VIN#
FROM
34
13� VEH.YEAR2OO9 MAKE STRN MODEL VUE STYLE VEHICLE TOWEDNOOpLSABLIN TQyED.BLRS yOES❑ENO✓
HICLE
DAMAGE IILLJJII ttSSAA1IVV/it�66
REGISTERED OWNER INFO SUNG KIM 1117 S 23RD ST RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE INSURANCE CO AARP 55PHL190006
IN EFFECT &POLICY# �1'OP
AR
VEwcLE GE CH ❑ 36
LEGALLY Yes❑NO❑ CITATION# BOTTOM
15❑ STAIN,DIING
UNIT U2 VEHICCLE ❑ CYCLE ❑ PEDESTRIAN ❑ OWNERRTY ✓❑ DYESMOTO PEDAL- ✓ NO OLD MET PHONE
16❑
LAST NAME PUGET SOUND ENERGY FIRST NAME MIDDLE
INITIAL
17❑ STREET ❑', 6905 S 228TH ST CITY' KENT ST WA ZIP 98032 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 LLIICENS # STATE SEX U MMDDYY —❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
VE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
C.ARNOLD 12509 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EH18028
COLLISION REPORT III III III III III 111
1591972 CASE# 26-4729
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.
MMDDYYYY. -
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. 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.
C.ARNOLD 06-17-26 03:49 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 7/5/2026 5:3834 PM
BADGE OR ID# 12509 ORI# WA0171300 TIME POLICE DISPATCHED; 2:23 Pry TIME POLICE ARRIVED',2:31 PM
PART I PAGE IT]OF 4�
REPORT NO. EH18028 CASE# 26-4729 OF COLLISION
06/17/26 14:19
OF CbLLI510N
NARRATIVE
CC 26-4729
On 6/17/2026 at 1427 hours I was dispatched to a motor vehicle collision at the intersection of Talbot
Rd S and S 21 st St in the City of Renton, King County, Washington.
Pre-Collision
Driver 1 stated that she was traveling North on Talbot Rd S approaching S 21st St in the #1 lane.
Collision
Driver 1 stated that she was thinking about how it would be bad if she were to fall asleep while
driving. Driver 1 stated that while thinking, she crossed over the center line into the oncoming lanes of
travel at the bend in the roadway. Driver 1 stated that upon doing so, she then left the roadway into
the grass where the front bumper of Unit 1 collided with a PSE owner power pole. This caused an
active power line to fall and break, then sparking and igniting a small patch of dry grass on fire. This
fire was extinguished quickly and did not result in significant damage per my observation.
Injuries
Driver 1 complained of injury and was transported to Valley Medical Center via ambulance.
Vehicle Disposition
Unit 1 was towed from the scene after being disabled.
Final Disposition
This report is to document this incident for insurance purposes. Driver 1 did leave the roadway and
collide with a static power pole.
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 Officer C. Arnold #12509 at 15:45 on 6/17/2026 in the City of Renton, King
County, Washington.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: DRIVER LOST IN THOUGHT
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORTNO.! EH18028 CASE# 26-4729 DATE AND TIME 06/17/2614:19
OF COLLISION
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PAGE 4 OF 4