HomeMy WebLinkAbout23-790 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ RESULTED ❑ CASE 23-790 z
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
CowsloN 01 - 18 - 2023 1734 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
PARK AVE N BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e N 3RD ST
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252015761 0 11
30
6❑ LAST NAME AN FIRSTNAME XIA MIDDLE 1 2 31
INITIAL
STREET ❑ 800 N 6TH ST BLDG 10-12 CITY RENTON ST WA ZIP 98057 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO I INTERLOCK YES NO YES R NO
8❑ DRIVER'S STATE SEX'F I D.O.B. 06 1- 10 - 1975 2 32
LICENSE# MMD)3YY
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U S 2 CLAY 1 NATURE OF INJURIES 2❑
3
LICENSE 366TGQ sTAr� FL vrN# JM3KFACM9K0580063
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T /g[ GOVT.VEHICLE 5 1 34
13 2 2019 MAZD CX5 UT DAMAGE YES NOBS YES : No✓
REGISTERED OWNER INFO AVIS/BUDGETRE11,413150 S 160TH ST SEATTLE WA 98188 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO
14 LIABILITY INSURANCE� AVIS/BUDGET RENTAL INSURANCE RENTAL AGREEMENT#432155102
IN EFFECT &POLICY# 9TOP
36
VEHICLe CHARGE 5❑NO❑ CITATION# 10 BOTTOM
15❑ LEGALLY,
YES 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4258919680
16 a
LAST NAME LEE FIRST NAME JANE MIDDLE I S
INITIAL
17❑ STREET ❑', 420 S 46TH PL UNIT D CITY' RENTON ST WA ZIP 980556383 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19 LDIIVEW # STATE WA ]SEX IF M .C... 01 21 1960 El 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE ARA5549 rare.WA VIN# KMHCT5AE6EU177014
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
TOWED BY GOV HI 44
VEH YEAR 2014 MAKE yyUN MODEL ACCENT STYLE $D DAMAGE TOWED✓ NOO BLIN BANKERS YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#ECO AMERICAN FAMILY CONNECT A100650444 STOP 5
IN EFFECT
vewcLE YES N❑ ,J� CITATION# CHARGE to BOTTOM
LEGALLY J
25 s 7 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
D.LAMOTHE 11677 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED26358
COLLISION REPORT III III III III III 111
1591972 CASE# 23-790
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DECASTILHOS RYAN S
(LAST FIRST,
ADDRESS&PHONE#
4252015761 SEX' M MMDDYYYY -❑
PASSENGER UNIT# I SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
[:]WITNESS❑✓ POS. USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O 8
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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.
D.LAMOTHE 01-18-23 06:46 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 111912023 8:06:52 AM
BADGE OR ID# 11677 ORI# WA0171300 TIME POLICE DISPATCHED 5:38 PM TIME POLICE ARRIVED 5:43 PM
PART I PAGE IT]OF 4�
REPORT NO. ED26358 CASE# 23-790 OF COLLISION
01/18/23 17:34
OF CbLLI510N
NARRATIVE
On the above listed date and time I was dispatched to the intersection of Park Ave N and N 3rd St, in
the City of Renton, County of King, State of Washington, reference a two vehicle collision. Upon
arrival, I observed Vehicle #1 facing southbound in the northbound lane on Park Ave N and Vehicle
#2 facing northbound in the same lane further north.
Vehicle #1 had heavy damage to the rear passenger wheelwell and the wheel was off its axle.
Vehicle #2 had moderate to heavy damage on the front passenger side corner of the vehicle.
I spoke to Driver#1 who stated she was traveling southbound on Park Ave N in the #2 lane (closest
to the double yellow center lines) with a green light. She stated she made a left hand turn onto Park
Ave N, following the vehicle ahead of her. While she was turning, she was impacted by Vehicle #2.
Driver#1 stated she did not remember seeing a green arrow prior to turning. I had to explain to Driver
#1 that a green arrow only grants her the right of way to travel straight through the intersection, and
does not grant right of way to make a turn across another lane of travel.
Driver#1 is visiting the area from China and is here on business for approximately two weeks. She
did not possess a US driver's license, but shows me her Chinese driver's license. She was identified
via her passport. Vehicle #1 is a rental vehicle. I viewed the rental agreement sheet, which listed
payment for liability insurance through Avis/Budget.
I spoke to Driver#2 who stated that she was traveling northbound in the #2 lane on Park Ave N. She
stated as she went through the intersection with N 3rd St, her vehicle impacted with Vehicle #1,
however she was unsure where Vehicle #1 had come from.
Both drivers stated they were uninjured and declined medical attention.
I spoke with Ryan S. Destilhos, who stated he was on west side of the intersection at N 3rd St. He
stated he did not observe the collision as it occurred but he heard the collision and looked up to see
Vehicle #1 in the process of making a left turn. He stated that he observed that both lights for north
and south lanes of travel were both green. He stated he did not see any green arrows.
Both vehicles were towed from the scene by Bankers towing.
Driver#1 was issued a verbal warning for failure to grant right of way/ improper left turn.
PAGE 3 OF 4
REPORT NO. ED26358 CASE# 23-790 DATE AND TIME 01/18/2317:34
OF COLLISION
Park:Av.N
a t�,
N 3r St
2
Dag—riot to:scald
PAGE 4 OF 4