HomeMy WebLinkAbout23-7198 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED73798 170
27
COLLISION REP FIT 1591971
CASE 23-7198 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#TRIBAL OF OZ OBJECT 1 1 8 28
UNITS
RESERVATION I I
STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
CowsloN 06 - 1-- 2023 1634 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 830
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e 0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254897880 0 11
30
6� LAST NAME NGUYEN FIRSTNAME TAN MIDDLE N 1 F 2 31
INITIAL
STREET ❑ 220 S 48TH ST,UNIT B CITY RENTON ST WA 21P 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 H USE 2 7 CLASS BACK PAIN[NATURE OF JURIES 2❑
3
,OF
P1 ATNES# ANF3569 sTAr WAuN# 4T18F1FK1DU695721
[---- TRAILER STATE TRAILED STATE
11 3 5 PLATE# PLATE# IR.. To
TRLR. TRLR 3 1 33
12 3 VIN#' VIN#
>;. FROM TO
5
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 2013 TOYT CAMRY P4 DAMAGE YES YES[:] NO
❑
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
4 INSURANCE CO 3 4
14 INSURANCE STATE FARM 464 9837 BIS-47
IN EFFECT EFFEE CT &POLICY# � 9TOP
VEHCLE CHARGE 36
LEGALLY YEs❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064897880
16 a
LAST NAME NGUYEN FIRST NAME PAUL MIDDLE H
INITIAL
17 STREET❑ NEW ADDRESS❑' 2115 SHATTUCK AVE S CITY RENTON ST WA ZIP 98055 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK v�Esl I I NOF YES
t l NO�
19 D IVEW # STATE WA SEX M M D.O.B. 03 _ 13 _ 2005 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑ILICENSE 21❑ PLA E# ARN9142 TArE 41
WA VIN# JT2BF22K7Y0276830 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
VEH YEAR 2000 MAKE TOYT MODEL CAMRY STYLE P4 VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DUC NGUYEN 2115 SHATTUCK AVE S RENTON WA 98055 D:2068612922 N:2068613002 VEHICLE NO.2
SHADE DAGED AREA
4
LIABILITY INSURANCE INSU&PORGY#E CO ECONOMY INSURANCE 0315758770 5
IN EFFECT
"'LE ❑ ,.I— CITATION# CHARGE C�Q
LEGALLY YES N`LJ
25 s � e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
DES/REE SCOTT 10272 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED73798
COLLISION REPORT III III III III III 111
1591972 CASE# 23-7198
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NGUYEN HUONG B
(LAST FIRST,
ADDRESS&PHONE#
220 S 48TH ST#B RENTON WA 98055 4256870762 SEXi F MMDOYyvv 12 - 15 - 1942
PASSENGER Z WITNESS 0 UNIT# 1 POS USE CLASS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELMET LASS NATURE OF INJURIES
' '1
NAME
(LAST,FIRST,MIDDLE INITIAL) CHEN YI Y
ADDRESS&PHONE#
5701 S AUGUSTA ST SEATTLE WA 98178 2064584842 SEX' M MMobvvvv 03 _ 13 _ 2005
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
DESIRES SCOTT 06-26-23 09:30 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 6/26/2023 9:57:05 AM
BADGE OR ID# 10272 ORI# WA0171300 TIME POLICE DISPATCHED 4:38 Pry] TIME POLICE ARRIVED:4:42 PM
PART Ei PAGE IT]OF 4]
REPORT NO. ED73798 CASE# 23-7198 OF COLLISION
06/25/23 16:34
OF CbLLI510N
NARRATIVE
On 6/25/23 around 1636 hours I was dispatched to the 830 block of Talbot RD S (City of Renton,
County of King and State of Washington) due to a report of a vehicle collision.
Upon arrival I saw that both vehicles were stopped in Lane #2. 1 had both vehicles move into the
Home Depot parking lot. I spoke to Driver#1 who stated that he was pulling out of the Home Depot
parking lot and making a right hand turn to go North bound on Talbot RD S. Driver#1 stated he
pulled into Lane #1 and was about 15 feet from where he entered the roadway when he was struck
from behind. Driver#1 stated he never saw Vehicle #2 but believes that vehicle #2 struck him directly
in the rear of his vehicle. 1 saw Vehicle #1 had damage to its driver's side rear side panel, bumper,
undercarriage. Driver#1 complained of back pain. Passenger#1 did not report any injuries.
Driver#2 stated he was headed North bound on Talbot RD S traveling with traffic in lane #2 when
Driver#1 pulled out of the Home Depot parking lot making a right hand turn. Driver#2 stated that he
saw Driver#1 cross straight across lane #1 and head directly in front of him in Lane #2. Driver#2
stated he locked up his brakes trying to avoid Vehicle #1 that was coming straight at him into his
traffic lane #2. Driver#2 stated Vehicle #1 struck Vehicle #2 front passenger side quarter panel
causing damage to the hood and front bumper. Passenger#2 and Driver#2 did not report any
injuries. I spoke to Passenger#2 who stated the same, that Driver#1 pulled out of the Home depot
parking lot and right into their lane. I looked out into the road and saw skid marks in lane #2 where
the collision occurred.
PAGE 3 OF 4
REPORT NO. ED73798 CASE# ' 23-7198 DATE AND TIME 06/25/23 16:34
OF COLLISION
4:
;Z)
Homedepot parking lot.
PAGE 4 OF 4