HomeMy WebLinkAbout23-1844 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-1844 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 02 - 1-- 2023 1503 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
DUVAL AVE NE BLOCK NO. e✓ 1500
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254965782 0 11
30
6� LAST NAME WASHINGTON FIRSTNAME XAVIER MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 4455 NE12TH ST APT 22-12 CITY RENTON ST WA 21p 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10 P1 ATE 14 D293028 sTAT WAu N# 1 GTW7BFP4P1108633
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 5 VIN#j VIN#
FROM TO
❑ VEH.YEAR 2023 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 1 5 34
13 4 GMC SA VANA VN DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO EAN HOLDINGS 14002 E 21ST ST STE 1500 TULSA OK 74134 D:4252206117 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE z INSURANCE CO THEIMER LOGISTICS INC 00702974.3 4
LI EFFECT I SUR N# TOPVENICLE CHARGE 36
LEGALLv res❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064095793
16 a
LAST NAME PHAN FIRST NAME CHI MIDDLE T
INITIAL
17❑ STREET ❑ 1209 QUEEN AVE NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS I I I I I ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES
t t- l NO❑
19 LDIIVER # STATE WA SEX M MMDDW 08 _ 24 1971 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE 388VNM TATE I WA VIN# JTJBT20X850093041
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE El
23❑ 43
TRLR RLR
VIN#. N I #.
TOWED BV Gov HI 44
VEH YEAR 2005 MAKE LEX$ MODEL GX 460 STYLE UTDAMAGE TO WED NOO✓ BLIN YES
NO
24❑ Yr
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04115-12-75-34IN 1 9TOP
'E""LE ❑ N`L J
,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES
25 $ '
=KI
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12598 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED37025
COLLISION REPORT III III III III III 111
1591972 CASE# 23-1844
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) HUYNH LANG T
(/AST FIRST,
ADDRESS&PHONE# D O.B.
1209 QUEEN AVE NE RENTON WA 98056 SEX F MMDDYyry 02 - 26 - 1978
PASSENGER WITNESS UNIT# SEAT AIRBAG' RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 4 1 USE CLASS 11
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX MMDDYYYY
PASSENGER ❑WITNESS❑ UNIT# : SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
On Tuesday, February 14, 2023 at 1504 hours, I was dispatched to a two-vehicle collision in the area
of Duvall Ave NE and NE Sunset Blvd.
The following occurred within the City of Renton, King County; Unit 1 - WA/ D29302B was being
driven by Xavier Washington and was driving southbound on Duvall Ave NE in the 1500 block. Unit 2
- WA/ 388VNM was driven by Chi Phan and was travelling southbound in the right turn lane in the
1500 block of Duvall Ave NE. Xavier stated was driving behind Unit 2 and an unrelated vehicle
attempted to merge in the lane which caused Unit 2 to brake quickly. Xavier stated he was unable to
avoid colliding with Unit 2. The front bumper of Unit 1 crashed into the rear bumper of Unit 2. The
driver of Unit 2 stated he had to brake quickly for a vehicle that was attempting to merge in front of
him when he applied the brake and was struck from behind.
Both vehicles sustained damage and neither vehicle needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISNIEWSKI 02-14-23 04:06 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
J.CHRISTIANSEN 10437 2/24/2023 6:18:02 PM
BADGE OR ID# 12598 ORI# WA0171300 TIME POLICE DISPATCHED 3:04 PM TIME POLICE ARRIVED]3:07 PM
PART I PAGE 2�OF❑
REPORT NO. ED37025 CASE# ' 23-1844 DATE AND TIME 02/14/23 15:03
OF COLLISION
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NOT TO SCALE
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Ill
UNIT I
a
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POINT OF IMPACT--- O
�r
UNIT 2"�
NE SUNSET SLVD
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