HomeMy WebLinkAbout23-5978 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-5978 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 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# ❑
cawsloN 05 - 1-- 2023 2210 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 43RD ST BLOCK NO. e✓ 300
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:9086920688 0 11
30
6❑ LAST NAME REID FIRSTNAME ALYSSA MIDDLE M 1 2 31
INITIAL
STREET ❑ 22501 SE 267TH ST CITy MAPLE VALLEY ST WA Zlp 98038 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 07 1- 07 - 2004 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
LICENSE CFG9346 STATE WA uN# 1N4BL4CW6PN300698
10 9❑ Pr ATE�
11[-jTRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.M ro
TRLR. TRLR. 5 1 33
12 0 0 VIN#' VIN#
:: FROM TO
VEH.YEAR 2023 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 3 7 TOWED BY GOVT.VEHICLE 34
13 4 NISS ALTIMA SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO GEICO 6120-93.94.49
IN EFFECT &POLICY# 9TOP
vewoLe 1 5 36
LECAIIv YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ,/ D:2068996456
16 a
LAST NAME NGUYEN FIRST NAME TRUNG MIDDLE ID
INITIAL
17❑ STREET NEW ADDREs�' 229 ANDOVER PARK E UNIT 1615 CITY TUKWILA ST WA ZIP 98188 37
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK Y�EsI I I NOF YES
t l NO�
19 LICENSE# STATE WA SEX M M D.C.B. 12 _ 26 _ 1983 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE ❑21❑ PLA E# BXR4490 TATE WA VIN# 41
KMHL54JJ7MA017029 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2021 MAKE yyUN MODEL SONATA STYLE $D DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO ALLSTATE 817422505IN STOP 5
VEHICLE ,.I—I CITATION# CHARGE
25 to BOTTOM
LEGALLY YES❑ N
' a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MICAH BATTLE 12049 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73318
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5978
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'
Unit 1 was identified as Alyssa M. Reid (07/07/04) who was driving WA-CFC9346.
Unit 2 was identified as Trung D. Nguyen (12/26/83) who was driving WA-BXR4490.
Unit 1 stated they were pulling out from the south side onto S 180th St to go across all lanes of traffic
northbound to ender the shopping center on the north side of road. Unit 2 struck them on the
passenger side.
Unit 2 stated he was driving eastbound on S 180th St when Unit 1 pulled out in front of him, and he
collided in the passenger side of Unit 1.
I observed moderate body damage to the passenger side of Unit 1, and minor body damage to the
front bumper of Unit 2.
Unit 2 showed my dashcam footage of the incident which depicted exactly what both parties had
described. He was instructed to upload the footage into evidence via AXON.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAH BATTLE 05-27-23 01:00 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 6/24/2023 1:11:17 PM
BADGE OR ID# 12049 ORI# WA0171300 TIME POLICE DISPATCHED 10:14 PM TIME POLICE ARRIVED 10:22 PM
PART Ei PAGE IT]OF
REPORT NO. ED73318 CASE# 23-5978 DATE AND TIME 05/26/23 22:10
OF COLLISION
300 BIk S 180th st(S 43rd St)
*Not drawn too scale
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