HomeMy WebLinkAbout23-7094 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-7094 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# ❑
cowsloN 06 - 1-- 2023 1035 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 3300
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 00 FMILES EET e S ❑ W e MONROE AVE NE
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254058311 0 11
30
6� LAST NAME ADAMS FIRSTNAME RACHEL MIDDLE J 1 1 2 31
INITIAL
STREET El876 HOQWAM AVE NE CITY RENTON ST WA Zlp 980594673 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO YEs No�/
8❑ LRIIVERCENS # STATE WASEX'F MM D Y' 03 — O6 — 1990 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CLASS 1 NATURE OF INJURIES z❑
3
10 99 Pi ATNES# CFV7532 srATe WAV N# JTEPU5JR5P6105889
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 3 7 33
12 3 5 VIN# vIN
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2 2023 TOYT 4RUNNE DAMAGE YES�NO YES❑ NO✓
REGISTEREDOWNERINFO RACHEL ADAMS 876HOQUTAM AVE NE RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE U INSURANCE CO AMERICAN FAM INS 2505.0763.06.86-FPPA-WA 3 4
IN EFFECT &POLICY# 9TOP
ve FFE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# W23045498 IMPROPER LANE USAGE o eorrom
15❑ STANDING 8 7 6
MOTOR PEDAL- ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ OWNER ❑ YES 1/ NO D:2066641651
16 a
LAST NAME WONG FIRST NAME ROY MIDDLE H
INITIAL
17❑ STREET ❑', 3215 S 170TH ST BLDG CITY' SEATAC ST WA ZIP 981880000 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER # STATE WA SEX M M .C... 05 _ 25 _ 2005 0 39
HELMET I INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CAK0812 TATE WA VIN# KM8J3CA24GU220981
❑ 41
PLATE#
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2016 MAKE HYUN MODEL TUCSON STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO PHUNG VONG 3215 S 170TH ST SEATAC WA 98188 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO STATE FARM 500 6139-C13-47AIN I STOP 5
VEHICLE ES[:] C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YN
25 s a
7.FF1CJEO-S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
HNSON 0505 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED72965
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7094
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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 URE OF INJURIES
NAT
❑ ❑ 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.
CO.JOHNSON 06-23-23 08:52 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 6/23/2023 10:55:41 AM
BADGE OR ID# 0505 OR]# WA0171300 TIME POLICE DISPATCHED 10:58 AM TIME POLICE ARRIVED',11:02 AM
PART I PAGE IT]OF 4]
REPORT NO. ED72965 CASE# 23-7094 OF COLLISION
06/22/23 10:35
OF CbLLI510N
NARRATIVE
WB 3300 blk NE 4th St, U1 lane 2, U2 lane 1; U1 changed lanes to right and collided with U2; U1
pass fender into U2 dvr door
On 06-22-2023 at about 1058 hours, I was dispatched to a collision in the vicinity of NE 4th St and
Monroe Ave NE in the City of Renton, County of King, Washington. There were no injuries reported
and both vehicles were pulled into a nearby apartment complex parking lot. I arrived in the area at
about 1102 hours.
The driver of Unit 02 was identified by WA DL and admitted to driving the listed vehicle. The driver
said he was wearing a seatbelt and not injured as a result of the collision. Unit 02 was west bound in
lane #1 (of 2) of the 3300 block of NE 4th St. Unit 02 was going straight ahead in their lane of travel
when Unit 01 came into the lane and collided with the driver side of Unit 02.
The driver of Unit 01 was identified by WA DL and admitted to driving the listed vehicle. The driver
said she was wearing a seatbelt and not injured as a result of the collision. Unit 01 was west bound
in lane #2 (of 2) of the 3300 block of NE 4th St. Unit 01 changed lanes from lane #2 to lane #1 and
collided with Unit 02. The driver of Unit 01 said she did not see Unit 02 prior to the lane change and
believed Unit 02 was in her blind spot.
There was moderate damage to the passenger side fender of Unit 01 and moderate damage to the
driver door of Unit 02. The damage to the vehicles was consistent with the information provided by
both drivers.
The predominant factor leading to the collision was the driver of Unit 01 failing to ensure lane #1 was
clear prior to conducting the lane change. Per RCW 46.61.140, a vehicle shall be driven as nearly as
practicable entirely within a single lane and shall not be moved from such lane until the driver has first
ascertained that such movement can be made with safety. If not for the actions of the driver of Unit
01, the collision would not have occurred. The driver of Unit 01 was issued a written warning.
PAGE 3 OF 4
REPORT NO. ED72965 CASE# ' 23-7094 DATE AND TIME 06/22/23 10:35
OF COLLISION
AwFqftb
Unt02 Ur,401'
NE 4t'h St
"Not to Scale"
Monroe Ave NE
PAGE 4 OF 4