HomeMy WebLinkAbout23-3438 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED50501 170
27
COLLISION REP FIT 1591971
CASE 23-3438 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4300 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
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#
cowsloN 03 - 1-- 2023 1248 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SUNET BLVD N BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e N 3RD STREET
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4257374293 0 11
30
6❑ LAST NAME KENNEDY FIRSTNAME SEAN MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 19240 51 ST AVE NE CITY LAKE FOREST PARK WA
NEW ADDRESS ST 21P 981552941 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LDRIVER # STATE WA SEX'M MID
LOB 05 1- 27 - 1981 1 1 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� AHZ6826 sTAT� WA urN# WVWED7AJ3CW208563
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. A'RLA2 1 5 33
12 0 0 VIN#j VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2012 YOLK GTI HB DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO SEAN KENNEDY 1924051ST AVE NE LAKE FOREST PARK WA 98155 D:4257374293 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO USAA P0138456457101 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE
15❑ 5 36
LECALLv YES❑NO❑ CITATION# CHARGE 1 o BOTTOM
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4258668722
16 a
LAST NAME LEE FIRST NAME KA MIDDLE W
INITIAL
17 STREET I❑ s❑' 5849 NW LAC LEMAN DR CITY' ISSAQUAH ST WA ZIP 980277823 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 07 28 _ 1963 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CAP8847 TATE 41
WA VIN# 3MVDMBEY7MM272997 1
42
22❑ PLATE# STATE PLATE ILER# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE MAZp MODEL CX-5 STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO BOWIE LEUNG PO BOX 330 WILLIAMSVILLE NY 14231 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO PROGRESSIVE 964354683IN 1 9TOP 5
VEHICLE YES[:] ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY N
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HUBERMANN ALCEAN 12681 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED50501
COLLISION REPORT III III III III III 111
1591972 CASE# 23-3438
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CHEUNG YEE M
(LAST FIRST,
ADDRESS&PHONE# D O.B.
5849 NW LAC LEMAN DR ISSAQUAH WA 980277823 4258668722 SEX F MMDDYyry 11 - 26 - 1968
PASSENGER Z WITNESS UNIT# 2 SEA 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET INJURY NATURE OF INJURIES
POS. USE 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYVYV
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
HUBERMANN ALCEAN 03-26-23 05:57 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 1 411112023 8:41:15 PM
BADGE OR ID# ! 12681 OR]# WA0171300 TIME POLICE DISPATCHED 12:55 PM TIME POLICE ARRIVED',1:20 PM
PART I PAGE IT]OF 4�
REPORT NO. ED50501 CASE# 23-3438 OF COLLISION
03/26/23 12:48
OF CbLLI510N
NARRATIVE
Assignment:
On 03/26/23 at around 1255 hours, I was dispatched to collision at the intersection of Sunset Blvd N
and N 3rd St. This address is in the City of Renton, County of King, State of Washington.
Observation:
Upon arrival, I observed both vehicles were parked at the Burger King's parking lot. I asked if anyone
needed any medical attention and all parties said no.
I observed minor damage to the front passenger side bumper of Vehicle #1. 1 observed minor
damage to the driver side bumper of Vehicle #2.
Vehicle 1:
Driver#1 said that he was traveling southbound on Sunset Blvd N in the #3 lane (3rd lane from the
center double yellow line). He was merging from the #3 lane to #2 lane to eventually cross over to the
left turn lane. The driver of Vehicle #1 said he did not check his blind spot and hit the back bumper of
Vehicle #2 with the front passenger side corner of his vehicle.
Vehicle 2:
Driver#2 said he was traveling southbound Sunset Blvd N in the #2 lane (2nd lane from the center
double yellow line) when Vehicle #1 hit the back bumper of his vehicle as he coming to a stop at a red
light.
Disposition:
I completed an exchange form and provided a copy to both parties. A verbal warning was given to the
Driver#1.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
This report was electronically signed by Officer H. Alcean #12681, at 1642 hours on March 26, 2023
PAGE 3 OF 4
REPORT NO. ED50501 CASE# ' 23-3438 DATE AND TIME 03/26/23 12:48
OF COLLISION
Sunset Blvd nm
N
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