HomeMy WebLinkAbout23-6942 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
CASE 23-6942 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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 CITY#
COLLISION.. 06 - 18 - 2023 1952 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SE 128TH ST BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 158THAVE SE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:6414512897 0 4 30
6� LAST NAME FITZGERALD FIRSTNAME MICHAEL MIDDLE J 1 1 2 31
INITIAL
STREET ❑ 554 INDEX PL NE APT 1 CITy RENTON ST WA Zjp, 980563700 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES R No
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� CDM4139 sTArI WAvIN# JTKJF5C7XFJ010104
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 7 1 34
13 4 2015 TOYT SCION YES NO � �MEYER YES[:] No✓
DAMAGE
REGISTERED OWNER INFO MICHAEL FITZGERALD 154INDEX PL NE APT 1 RENTONWA 98056 D:6414512897 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILI INSURANCE INSURANCE CO 4454999089 GEICO
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERMOTO PEDAL RTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME VU FIRST NAME LOC MIDDLE I V
INITIAL
17 STREET❑ NEW ADDRESS❑' 15800 SE 128TH ST CITY RENTON ST WA ZIP 980598520 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDIIVEW # STATE WA SEX M MMDDW 04 16 _ 1952 39
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLATE III BOJ5357 TArE WA VINIi 1HGCM82605A014422 41
1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2005 MAKE HOND MODEL ACCORD STYLE VEHICLE TOWED TO BLIN TOWED BY GOV HI 44
24❑ DAMAGE YES✓ NO YES NO✓
REGISTERED OWNER INFO THANH TRAN 651643RD AVE S SEATTLE WA 98118 D:2062352241 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 176 6767-C19-47BIN I GD
VEwGLE ❑ ,J� CITATION# CHARGE
25
LEGALLY YES N`L J
s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
JAKE GALL 12617 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED76220
COLLISION REPORT III III III III III 111
1591972 CASE# 23-6942
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) TRAN THANH T
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
6516 43RD AVE S SEATTLE WA 981180000 SEXi F MMDOYyry 08 - 07 - 1962
PASSENGER Z WITNESS UNIT# 2 PEAT OS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET NATURE OF INJURIES
USE 2 CLASS
'1
NAME
(LAST,FIRST,MIDDLE INITIAL) TRAN CAROLYN T
ADDRESS&PHONE# Ly O B
6516 43 AVE S SEATTLE WA 981180000 SEX IF MMbbvvvv 04 _ O6 _ 2002
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 PGS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
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.
JAKE GALL 06-19-23 12:04 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.TOLLIVER 10540 7/3/2023 6:25:51 PM
BADGE OR ID# 12617 OR]#' WA0171300 TIME POLICE DISPATCHED! 7:53 PM TIME POLICE ARRIVED',7:59 PM
PART I PAGE IT]OF 4�
REPORT NO. ED76220 CASE# 23-6942 OF COLLISION
06/18/23 19:52
OF CbLLI510N
NARRATIVE
*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. Statements have been paraphrased and
summarized. *
The following occurred within the City of Renton, King County WA and was recorded on my Body
Worn Camera.
On 06/18/2023 at around 1952 hours, I was dispatched to a collision located at the intersection of SE
128th ST and 158th Ave SE. I arrived on scene and located both vehicles pulled off to the side of the
road.
Vehicle 1 had heavy damage to the front driver side quarter panel/wheel and vehicle 2 had heavy
damage to the rear passenger side quarter panel.
I spoke with driver 1, who provided me with all the necessary documentation. Driver 1 stated that he
was traveling East on SE 128th ST in the far-left lane (2/2). As driver 1 came over the crest of the
small hill, be observed vehicle 2 stopped in lane 2/2 waiting for traffic to turn left (North) into a
residential driveway. Driver 1 applied the breaks and began to skin on the wet pavement. Vehicle 1
drifted slightly to the right, which caused the impact on the driver side of vehicle 1 and rear passenger
side of vehicle 2. Driver 1 was uninjured.
I spoke with driver 2 who provided the same story. Driver 2 lives at 15910 SE 128th ST and was
attempting to turn into his driveway. He was stopped in lane 2/2 waiting for traffic to pass with his
blinker on. Driver 2 stated that driver 1 was driving too fast over the crest of the hill to stop in time.
Driver 2 and his two passengers were uninjured.
Vehicle 2 was able to drive off onto the owner's property across the street. Vehicle 1 was towed by
Gene Meyers towing.
I provided both driver an exchange of insurance information along with the case number.
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 J. Gall/12617
06/18/23 at 2355 hours, Renton, Washington
PAGE 3 OF 4
REPORT NO. ED76220 CASE# ' 23-6942 DATE AND TIME 06/18/23 19:52
OF COLLISION
SE 128TH ST
ar' ..NOT TO SCALE
m
m
PAGE 4 OF 4