HomeMy WebLinkAbout23-517 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ 23-517 z
RESULTED ❑ CASE
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 7 2$
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 01 - 13 - 2023 1812 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e HOQU/AM AVE NE
0 8 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4253012632 0 11
30
6❑ LAST NAME LE FIRSTNAME GUANG MIDDLE 1 2 31
INITIAL
STREET ❑ 15902 SE 172ND PL CITY RENTON ST WA ZIP 980588628 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'M MID
LOB 03 1- 02 - 1958 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� CDt 1156 sTArI WAurN# JTDDPMAE9N3021739
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 9 9 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2022 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 TOYT COROL DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO GUANG LE 15902 SE 172ND PL RENTONWA 98058 D:4253012632 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYINSURANCE 10386
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 36
LECALLv YES NO❑ CITATION# 10 BOTTOM
)o
15❑ STAIN,DIING 8 7 6
UNIT U2 VEHICCMOTOLE CYCLE ❑ PEDESTRIAN ❑ OWNER YES
❑ DYES NO THR OLD MET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY RENTON ST ZIP 4
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES
t l NO❑
19 LLIICENS # STATE SEX U MMDDYY -❑_ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑
LICENSE ❑21❑ PLA E# CFV1749 TAre 41
WA VIN# JA4LS31HXYP057302 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2000 MAKE MJTS MODEL MONTER STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO�/
REGISTERED OWNER INFO HUNTER BRIGHAM 950 HARRINGTON AVE NE S103 RENTON WA 98057 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO IUQ
5VE""LE ❑ ,J� CITATION# CHARGELEGALLYYES N J25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED32889
COLLISION REPORT III III III III III 111
1591972 CASE# 23-517
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.
JAKE GALL 01-13-23 07:54 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 211112023 1:53:05 AM
BADGE OR ID# 12617 OR]#' WA0171300 TIME POLICE DISPATCHED 6:24 PM TIME POLICE ARRIVED 6:36 PM
PART I PAGE IT]OF 4�
REPORT NO. ED32889 CASE# 23-517 OF COLLISION
01/13/23 18:12
OF CbLLI510N
NARRATIVE
PLEASE NOTE. SUSPECT VEHICLE IS VEHICLE #2 IN THIS COLLISION REPORT.
The following occurred within the City of Renton, King County WA and was recorded on my Body
Worn Camera.
On 01/13/2023 at around 1624 hours, I was dispatched to a hit and run that had occurred 10 minutes
prior located at the intersection of NE 4th St and Hoquiam Ave NE.
I arrived on scene and contacted the driver of the victim vehicle. Through language line, the driver
explained that he was in the left-hand turn lane on NE 4th St facing Eastbound, attempting to turn
North onto Hoquiam Ave NE. While waiting to turn, the suspect vehicle (bearing WA LIC CFV1749)
rear ended the victim vehicle from behind.
The suspect vehicle briefly pulled over but left the scene without providing insurance information. The
victim driver was only able to describe the passenger and not driver of the suspect vehicle. The
suspect vehicle was registered to 950 Harrington Ave NE Apt S-103.
The victim driver was not injured, and his vehicle appeared drivable. The victim driver provided all the
necessary documents.
I provided the victim driver my business card with the case number attached.
I later checked the area of the apartment complex at 950 Harrington Ave NE. I was unable to find the
suspect vehicle. I also was unable to contact anyone at Apt S103.
It is unknown if the RO of the suspect vehicle was the driver during the time of the Hit and Run. The
RO has a different address listed on his DOL return out of Newcastle.
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 J. Gall/12617
01/13/23 at 1947 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. ED32889 CASE# ' 23-517 DATE AND TIME 01/13/23 18:12
OF COLLISION
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NE 4th St
*NOT TO SCALE
PAGE 4 OF 4