HomeMy WebLinkAbout23-7763 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-7763 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
COLLISION' 07 - 1-- 2023 2226 17 =-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
NE SUNSET BLVD e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ e S ❑❑ FEET OFN SOUTHPORT DR
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2065829420 0 11
30
6❑ LAST NAME SMITH FIRSTNAME SAVON MIDDLE D 1 1 2 31
INITIAL
STREET 01 950 HARRINGTON AVE NE#321 CITY RENTON ST WA ZIP 98057 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LICENSE# STATE WA SEX'M I ELMMDDYY 07 - 04 - 1997 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CCM1086 sTArI WAvIN#' JT8BF28G1X0227968
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM TO
rRLR TRLR 3 5 33
12 0 0 VIN#' VIN#
>;. FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 1999 LEXS ES 250 SD DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE❑ INSURANCE CO eq�T3 4
IN EFFECT &POLICV# 9TOP
VE—LL CHARGE 1 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063727132
16 a
LAST NAME VO FIRST NAME VAN MIDDLE I T
INITIAL
17 STREET❑ NEW ADDRESS❑' 684 NEWPORT CT NE CITY RENTON ST WA ZIP 98056 4❑ 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[—] DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# 41
ATM7456 TArE WA VIN# 2T3RFREVOFW242404 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE TOYT MODEL RAV4 STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ D YES NO BANKERS YES NO
REGISTERED OWNER INFO VAN VO 684 NEWPORT CT NE RENTON WA 98056 D:2063727132 AMA VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#ECO AMERICAN FAMILY 41078 09692 78 STOP 5
IN EFFECT
VE—LE ❑ ,J� CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N J
' 6
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26GROZAV 12489 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED77821
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7763
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 07-07-23 11:31 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 7/9/2023 12:59:21 AM
BADGE OR ID# ! 1Y489 OR]# WA0171300 TIME POLICE DISPATCHED 40:29 PM TIME POLICE ARRIVED 10:40 PM
PART I PAGE IT]OF 4�
REPORT NO. ED77821 CASE# 23-7763 OF COLLISION
07/07/23 22:26
OF CbLLI510N
NARRATIVE
CASE 23-7763
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events.
On Friday July 7th, 2023, at approximately 22:29, 1 responded to a 911 call regarding a two-vehicle
collision in the area of Ne Sunset Blvd and N Southport Dr within the City limits of Renton, King
County, Washington.
*** CALL REMARKS: ADRS FROM ANI/ALI, UNC 7....ON SUNSET BLVD....LANG BARR, 2 MVA,
RP REFUSING TO EXCHANGE INFO, PULLED OVER TO SIDE OF RD. JEO OFF RAMP FROM
SB 15 TO NE SUNSET BLVD. **CORRECTION NB 1405**
-UNIT ONE: BLACK 1999 LEXUS ES WASHINGTON LICENSE: CCM1086
-UNIT ONE DRIVER: SAVON D. SMITH (DOB: 07.04.1997)
-UNIT TWO: WHITE 2015 TOYOTA RAV 4 WASHINGTON LICENSE: ATM7456
-UNIT TWO DRIVER: VAN T. VO (DOB: 5.02.1967)
1 arrived on scene and contacted the involved parties and checked for injuries, Van said she was not
injured but was tired and nervous. Savon did not report any injuries from the collision. Van said she
was traveling east on N Southport Dr onto Ne Sunset Blvd when unit one turned in front of her. Van
indicated she had the green light to proceed through the intersection.
Savon indicated he was taking left turn onto northbound 1405 from Ne Sunset Blvd and had the green
light to turn. When he was completing his turn, unit two crashed into him in the intersection. Savon
believed he had the green light. Savon indicated he did not have vehicle insurance and a check of his
DOL status showed he did not have a valid license but was eligible.
Unit two had to be towed from the scene it was leaking coolant due to the front-end damage. Unit one
had damage to the front passenger side but was drivable. There were no passengers in either
vehicle.
All involved vehicles were provided a copy of the SECTOR exchange of information form.
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 7.07.2023 at 23:21 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. ED77821 CASE# 23-7763 DATE AND TIME 07/07/23 22:26
OF COLLISION
SOUTHPORT DR
N
NE Sunset Blvd
405 on-off ramp
PAGE 4 OF 4