HomeMy WebLinkAbout23-5140 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-5140 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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# ❑
CawsloN 05 - 07 - 2023 0300 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 2ND LANE BLOCK NO. e✓ 6120
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FMILES EET e S ❑ W e ROSARIO AVE SE
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YEs NO ,/ D:4253061298 1 4 30
6� LAST NAME LY FIRSTNAME THONG MIDDLE 1 2 31
INITIAL
STREET ❑ 6207 SE 3RD PL CITY RENTON ST WA ZIP 980597079 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 H U SE 9 1 INJURY CLASS 1 NATURE OF INJURIES z❑
3
10❑ PI ATE ASV8150 sTArI WAurN#' JNKAY01 E06M106228
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 7 33
12 0 0 VIN#' VIN#'
2006 INFI M35 SD plsA FROM 34
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO u BLIN TOWED BY GOVT.VEHICLE
13 2 DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO THONG LY 6207SE 3RD PL RENTON WA 98059 D:4253061298 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE Z INSURANCE CO SAFECO INSURANCE H2399045
IN EFFECT &POLICY# 9TOP
36
VE—LE CHARGE 5 ECALLv ❑NO❑ CITATION# 1 o BOTTOM
15❑ L STANDING YES 8 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO YES
❑ DYES NO SOLD MET PHONE
16❑
LAST NAME NONE FIRST NAME MIDDLE
INITIAL
17❑ STREET CITY ORLANDO ST ZIP $
NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
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 ❑
❑ILICENSE 21❑ PLA E# 708WCW TAre 41
FL VIN# LPSED3KA2ML016960 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ TRLR 43
RLR
UIN#. 'IN#.
YEAR 2021 MAKE TESL MODEL MODELS STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
VEH
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HERTZ VEHICLES LLC 5400 BUTLER NATIONAL DR ORLANDO FL 32812 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POLICY#E CO SELF INSUREDIN I STOP 5
vE""LE ❑ N,J� CITATION# CHARGE
LEGAL i o BOTTOM
LY YES 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
NATHANIEL BROWN 12765 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED61909
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5140
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
POS. 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.
NATHANIEL BROWN 05-07-23 03:49 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 1 512012023 10:00:47 AM
BADGE OR ID# 12765 ORI# WA0171300 TIME POLICE DISPATCHED; 9:38 AM TIME POLICE ARRIVED',9:53 AM
PART I PAGE IT]OF 4�
REPORT NO. ED61909 CASE# 23-5140 OF COLLISION
05/07/23 03:00
OF CbLLI510N
NARRATIVE
On 05/07/2023, at approximately 0938 hours, I was dispatched to a hit and run report at 6120 SE 2nd
Ln in Renton, King County, Washington. According to the individual who was renting vehicle 2,
identified by his Florida DL as Viet Nguyen, the vehicle he is renting was sideswiped on the driver's
side door and front wheel by vehicle 1 sometime overnight. Unit 2 is a grey 2021 Polestar 2 electric
vehicle (Florida license # 70BWCW) and it was legally parked on the street outside of the above
address. The driver of vehicle 1 did not notify Nguyen of the collision until an acquaintance of Nguyen
found vehicle 1 a block away in the morning. Vehicle 1 had a damaged passenger side mirror that
matched broken plastic pieces left near vehicle 2 after the collision as well as paint scuffs along the
entire passenger side of the vehicle. Nguyen stated he did not wish to pursue charges for the hit and
run because he lives in California.
According to the driver/owner of vehicle 1, identified by his WADL as Thong Ly, he was driving west
on SE 2nd Ln around 0300 hours when he accidentally hit vehicle 2 because it was dark out. Ly
admitted to colliding with vehicle 2 overnight. Upon inspection, I observed vehicle 2, a blue Infiniti
M35 (WA license #ASV8150), with paint scuffs along the entire passenger side of the vehicle and
broken passenger side mirror. The broken pieces of plastic matched the broken mirror on vehicle 1.
Photos were taken of the damaged mirror and paint scuffs. Ly stated he was "sorry" when asked why
he did not notify anyone about the collision.
The owner of vehicle 2, Hertz Vehicles LLC has not yet been notified of the collision and it is unknown
if they wish to pursue charges for the hit and run.
This report is for insurance purposes.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Weather: UNKNOWN
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. ED61909 CASE# 23-5140 DATE AND TIME 05/07/23 03:00
OF COLLISION
ly UNIT 2
i
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Not to scale
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UNIT 1
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