HomeMy WebLinkAbout24-563 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-ss3 2
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 STRUCK
RESERVATION
2
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 01 - 1-— 2024 2144 17 ❑-= S 8 IN e 1070 3
4 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
SUNSET BLVD NE ST e✓
MILEPOST 300 ❑
4a 1❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e I405 N RAMP
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2064229803 0 11
30
6❑ LAST NAME PHAN FIRSTNAME ANGELA MIDDLE H 1 1 2 31
INITIAL
STREET ❑ 13220 116TH AVE NE CITY KIRKLAND ST WA 7jp, 980342108 2
NEW ADDRESS
]❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 11 1- 05 - 2001 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CCM3070 sTArI WAvIN# 4T1C116K3NU056623
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 3 ] 34
13 3 2022 TOYT CAMRY SD DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO MUTUAL OFENUMCLAW AB80024620 3 4
IN EFFECT &POLICY# 9TOP
15 LE
vECALLv Hla.e 5 36
res❑NO❑ CITATION# CHARGE 1 o BOTTOM
❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:8126506406
16 a
LAST NAME KALALUKA FIRST NAME THANDIWE MIDDLE P
INITIAL
17 STREET 1RRINGTON AVE NE#206 CITY REARDAN ST WA ZIP 98056 4❑ 37
NEW ADDREs�' 1124 HA
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK yEs It I NOF YES
t l NOF,/
19[-] DRIVERS
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CJL6226 TArE 41
WA YIN# SGZCZ63457S868321 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GoI
VEH YEAR 2007 MAKE STRN MODEL V(fE STYLE UT DEHICLEAMAGE TOWED NOO✓ BLIN TOWED BY v HyES NO 1/ 44
24❑ fj
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO 9TOP 5
VE."LE ❑ ,J� CITATION# CHARGE
25 ' a i o BOTTOM
LEGALLY YES N J 1 0(7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 1 12489 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE42059
COLLISION REPORT III III III III III 111
1591972 CASE# 24-563
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.
BRYAN GROZAV 01-16-24 11:43 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 111912024 2:13:46 PM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED! 9:48 Pry TIME POLICE ARRIVED',9:52 PM
PART I PAGE IT]OF 4�
REPORT NO. EE42059 CASE# 24-563 OF COLLISION
01/16/24 21:44
OF CbLLI510N
NARRATIVE
CASE 24-563
This incident was captured on my body worn video camera and/or in-car dash camera. This report is
a summary of events that occurred and is not an exact sequencing of events.
On Tuesday January 16th, 2024, at approximately 21:52, 1 responded to a 911 call regarding a two-
vehicle collision at Sunset Blvd NE and the north bound 1405 on-ramp within the City of Renton, King
County, Washington.
***CALL REMARKS: UNK IF NE SUNSET BLVD OR SUNSET BLVD N** WSP OS..2 MVA..UNK
INJ...GRY TOYT CAMRY AND RED SATURN VIEW...
UNIT ONE: GRAY 2022 TOYOTA CAMRY WASHINGTON LICENSE: CCM3070
UNIT ONE DRIVER: ANGELA H. PHAN (DOB: 11.05.2001)
UNIT TWO: RED 2007 SATURN VUE WASHINGTON LICENSE: CJL6226
UNIT TWO DRIVER: THANDIWE P. KALALUKA (DOB:6.23.1989)
I arrived on scene and contacted the involved parties. I confirmed there no injuries. No one requested
aid and said they were fine. Thandiwe reported the following; she was traveling west on Sunset Blvd
NE when unit one turned in front of her to merge onto the 1405 on ramp. Thandiwe was the only
occupant in the vehicle at the time of the collision. Thandiwe indicated she did not have valid vehicle
insurance.
After talking to Thandiwe, I contacted Angela who reported the following; she was merging onto 1405
north on ramp when she was hit by unit two. Angela indicated she had never driven on the road
before or merged onto 1405 at that location and was confused. Angela was the sole occupant in the
vehicle at the time of the crash and had all the proper documents.
It was determined Angela failed to yield the right of way to Thandiwe who had the right of way.
I provided Thandiwe and Angela a copy of the SECTOR exchange of information form. Thandiwe
vehicles was towed from the scene since it was not drivable. Angela was able to drive away in her
vehicle since it had minor damages and able to drive.
This concludes my involvement in this case.
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 B. Grozav #12489 on 1.16.2023 at 23:41 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE42059 CASE# ' 24-563 DATE AND TIME 01/16/24 21:44
OF COLLISION
NOT TO SCALE
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