HomeMy WebLinkAbout23-7416 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7416 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 N E IN CITY#
cowsloN 06 - 1-- 2023 1049 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e S 130TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:7348348920 0 11
30
6� LAST NAME KONG FIRSTNAME LINGMEI MIDDLE N 1 2 31
INITIAL
STREET ❑ 3616 PALATINE AVE N CITy SEA
FT WA 2jp, 981038521 z
NEW ADDRESS II
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
LICENSE CFF8917 STATE WA u N# 4S4BRCCCOA3311008
10 9❑ Pr ATE�
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 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 ZO1O SUBA OUTBA DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO LINGMEIKONG3920STONEWAYNAPT320 SEATTLEWA98103 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO SAME. 3 4
IN EFFECT &POLICY# 9TOP
VeH'CLe CHARGE 5 36
LEGALLY YEs No clTAnoN# 3A0329685 FAIL STOP AT STOP o aorrom
15❑ STANDING 8 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT 02 ❑✓ ❑ PEDESTRIAN ❑ ❑ YES�/ No D:2069485481
VEHICLE CYCLE OWNER
16 a
LAST NAME NGUYEN FIRST NAME MY-DUNG MIDDLE I T
INITIAL
17❑ STREET ❑', 12256 76TH AVE S CITY SEATTLE ST WA ZIP 981784401 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 DRIVER'S STATE I WA ]SEX IF D.C... 07 07 1988 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE BOL9895 TATe WA vIN# 5TDBK3EH3DS241797
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2013 MAKE TOYT MODEL HIGHLAN STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO
REGISTERED OWNER INFO QUOC-CUONG NGUYEN 1225676TH AVE S SEATTLEWA98178 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IGQ'E""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED76157
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7416
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'
grn sub wag/unit 1 eb stop sign wht my T/unit 2
CC
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash at the intersection of
Renton Ave S at S 130th St.
I contacted the driver of unit 2 who told me she was south on Renton Ave when unit 1 entered the
roadway across her path where they made contact. Unit 2 did not complain of injury and damages
required a tow truck.
I contacted the driver of unit 1 ID'd by her picture WADL. She told me she was attempting to cross
Renton Ave from the west side to the east side. This is controlled with a stop sign. She told me while
she was crossing the road she made contact with unit 2. She did not complain of injury and damages
did not require a tow truck.
I cited Unit 1 Ref RCW 46.61.190 ftyrow from stop sign via complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 6/30/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 06-30-23 02:36 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOSS 1953 7/3/2023 3:20:22 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED 10:50 AM TIME POLICE ARRIVED 10:58 AM
PART I PAGE IT]OF 3�
REPORT NO. ED76157 CASE# ' 23-7416 DATE AND TIME 06/30/23 10:49
OF COLLISION
I
nts
m.�
i
i
i
i
i
PAGE 3 OF 3