HomeMy WebLinkAbout23-00919 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 6 27c
COLLISION REP FIT 1591971
CASE 23-00919 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT ❑2$
i TRIBAL UNITS 01 STRUCK UT/LITYPOLE
RESERVATION
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
GowsloN 01 - 22 - 2023 0100 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S PUGET DR BLOCK NO. e✓ 1400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e GRANT AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES ✓NO D:2068612447 30
6� LAST NAME VU FIRSTNAME GEORGE MIDDLE B 1 1 2 31
INITIAL
STREET ❑, 11457 SE 162ND ST CITY RENTON ST WA ZIP 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs 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❑ Pi aT�S� CDV8113 sTArI WAvIN# JHMAPf 1423T004043
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
RoM TO
m 34
13� VEH.YEAR 2003 MAKE yOND MODEL S200o STYLE CP IV
AMCLE TOWED NOO pLSABLIN T�'� LE TOWING VEHICLE
DAMAGE IILLJJII
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILI INSURANCE INSURANCE CO PEMCO CA1182286
IN EFFECT &POLICY# 9TOP
15❑ LE
vEGALLY HICLe 1 5 36
res�No D CITATION# 3A0174205 CHARGE IMPROPER LANE USAGE 1 o aorrom
STAIN.D'ING 8 7 6
UNIT a2 VE ICCLE ❑ CYCLE MOTO PEDAL- ❑ PEDESTRIAN ❑ OWNER
W RRTY ❑ DYES NO OLD MET PHONE
16 1-1
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
CITY' ST ZIP 4❑ 37
17❑ NEW ADDRESS❑'
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t l No❑
19 LLIRIVERSTICENS # STATE SEX MMDDYY -❑_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TArE 41
IN#LICENSE V f
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
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# T AGENCY
26
BRETT WILLET 12257 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED33479
COLLISION REPORT III III III III III 111
1591972 CASE# 23-00919
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.
BRETT WlLLET 01-22-23 07:21 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 2/13/2023 7:48:18 AM
BADGE OR ID# 12257 ORI# WA0171300 TIME POLICE DISPATCHED 4:39 AM TIME POLICE ARRIVED:4:53 AM
PART I PAGE IT]OF 4�
REPORT NO. ED33479 CASE# 23-00919 OF COLLISION
01/22/23 01:00
OF CbLLI510N
NARRATIVE
Portions of this incident were captured on my Body-Worn Camera. Please See that for complete
detail of witness statements and incident details.
On 01.22.2023, 1 was working for the Renton Police Department as 1-Robert-22, fully uniformed and
in a marked patrol vehicle. At approximately 0449 hours, I was dispatched to the S Puget Drive and
Grants Ave S. in the City of Renton, County of King, State of Washington to investigate a collision.
PERSON INVOLVED:
Unit# 01: 2003 Honda S2000, WA LIC# CDV8113; driven by: George B. Vu (DOB: 01.09.2004)
INCIDENT:
Unit# 01 was traveling eastbound on S Puget Drive approaching the intersection at Grant Ave S.
Unit# 01 overcorrected when a vehicle passed and put the vehicle into a spin. Unit# 01 spun
counterclockwise across the westbound lanes, went onto the sidewalk, and struck a PSE utility pole
(POLE # 1840, 317134, PSE #SLAT5882).
Airbags were not deployed, seatbelts were worn, and no injuries were reported on scene.
Unit# 01 was towed from the scene by Seattle Towing at the owner's request. PSE was notified
about the collision and that the lines were hanging about 8ft off the ground.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
ELECTRONICALLY SIGNED
Officer B. Willet# 12257
Renton, WA/ County of King
State Of Washington
01.22.2023
0712 hours
PAGE 3 OF 4
REPORT NO. ED33479 CASE# ' 23-00919 DATE AND TIME 01/22/23 01:00
OF COLLISION
PSE POLE#1840, 317134, PSE#SLAT5882
� _ I
NOT TO SCALE
CASE#23-09919 ~
W
UNIT#1 0
D
n
GRANT AVE S h
PAGE 4 OF 4