HomeMy WebLinkAbout23-6197 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-6197 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 3
HIT 8 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 05 - 1-- 2023 2042 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 1400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 3❑ 100 00 FEET e S MILES N B W e S PUGET DR
1 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2063551982 0 11
30
6� LAST NAME NGUYEN FIRSTNAME PHILLIP MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 12041 155TH AVE SE CITY RENTON ST WA 21p 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 1 RESTR 1 EJECT 3 HELMET 5 INJURY 6 NATURE OF INJURIES z❑
USE CLASS ABRASIONS AND BRUISING ON KNEE/SHOULDER
3
10 99 PI ATE 14 8E0604 STATE WA u N#' SMTDOONS27J298519
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2007 TRUM DAYTON MC DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ERIC MANIVANH 2220177TH STSE BOTHELL WA 98012 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY#VE"C CHARGE 36
LEGALLY YES No cTAnoN# 3A0452338 OP MOT VEH W/OUT INSURANCE U�,
5
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ DD 2068397879
16 a
LAST NAME PITRE FIRST NAME SAMAIYAH MIDDLE R
INITIAL
17 STREET❑ NEW ADDRESS❑' 17110 SE 276TH ST.APT A312 CITY COVINGTON ST WA ZIP 98042 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NoF,/
19 LDIIVER # STATE WA ]SEX IF M .C.B. 02 _ 15 _ 2005 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ 41
21❑ PLA E# CDV8838 TATE WA VIN# 19UUASF58CA017371 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2012 MAKE ACUR MODEL TL STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO CHERYL WRIGHT 17110 SE 276TH ST,APTA312 COVINGTON WA 98042 D:2068397879 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE I PORGY#ECO STATE FARM 5321049AI947IN 1 9TOP 5
VEHICLE YES LEGA ❑ NEE] CITATION# CHARGE i o BOTTOM
LLY
25 s e
7MAR
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
FERNANDES 12848 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73322
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6197
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.
MAR/A FERNANDES 06-01-23 12:06 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 6/24/2023 1:11:11 PM
BADGE OR ID# 12848 OR]# WA0171300 TIME POLICE DISPATCHED 8:47 Pry] TIME POLICE ARRIVED',8:54 PM
PART Ei PAGE IT]OF 4�
TIME
REPORT NO. ED73322 CASE# 23-6197 OF COLLISION05/31/23 20:42
NARRATIVE
On 05-31-2023 at approximately 2047 hours I was dispatched to the report of an injury collision at
1400 Talbot Rd. S. between a vehicle and a motorcyclist. At approximately 2054 hours I arrived and
contacted the involved parties.
Vehicle 1, a gray 2007 Trum Daytona, was on the westside of the road next to the driver, Phillip D.
Nguyen (DOB: 07-26-1997). Phillip was being treated by the Renton Regional Fire Authority for
abrasions to his knee and shoulder. Phillip said that he was driving his motorcycle southbound on
Talbot Rd. S, but could not remember if he was in the east or west lane. Phillip said he did not know
what happened or how he crashed, but remembered his motorcycle colliding with a vehicle, and then
falling onto the ground. Phillip said he recently bought the motorcycle but did not have any proof of
ownership and did not have proof of insurance. I observed damage to the left side of the motorcycle.
Vehicle 2, a 2012 black Acura TL, WA/ CDV8838, was parked just south of the motorcycle in the
southbound lane of Talbot Rd. S. I contacted the driver, Samaiyah R. Pitre (DOB: 02-15-2005), and
she provided me with her license, registration, and proof of insurance. Samaiyah said that she was
driving southbound on Talbot Rd. S, in the east lane, and vehicle 1 was driving next to her in the west
lane. The motorcycle was pacing her, and they were driving roughly the same speed. Samaiyah said
that the motorcycle drove into her lane and hit the right rear quarter panel of her vehicle. I observed
damage to the right rear quarter panel.
A witness, Paris Kimbrough, stated that she saw Phillip drive into Samaiyah's lane and strike her
vehicle, causing the collision. Phillip's motorcycle went down and he was ejected from the
motorcycle. Paris did not know why Phillip drove into Samaiyah's lane as his merge seemed
unprovoked.
I issued Phillip a citation #3A0452338 for Operating a Motor Vehicle Without Insurance.
PAGE 3 OF 4
REPORT NO. ED73322 CASE# 23-6197 DATE AND TIME 05/31/23 20:42
OF COLLISION
NOT TO SCALE
1400 TALBOT RD S
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