HomeMy WebLinkAbout23-8555 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8555 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#
cawsloN 07 - 1-- 2023 1302 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e S 7TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
NO D:2068188198 0 81
30
6� LAST NAME NGUYEN FIRSTNAME TRANG MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 1300 EAGLE RIDGE DR S APT R21 CITY RENTON ST WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs 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
10❑ PI ATE CGC1842 sTArI WAvIN#' 2T2HZMDA5tC216838
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR: 1 5 33
vIN#
12 0 0 ' YIN#
FROM TO
VEH.YEAR N MAKE LEXS MODEL RX STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE
DAMAGE YES NO J 9 34
13 2 YES❑ NO✓
REGISTERED OWNER INFO TRANG NGUYEN 1300 EAGLE RIDGEDR S APTR21 RENTON WA 98055 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO FARMERS. 3 4
IN EFFECT &POLICY# 9TOP
vErIICLE 5 36
LE—Lft Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ NDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063758044
16 2
LAST NAME VITHAYATHIL FIRST NAME SEBASTIAN MIDDLE I F
INITIAL
17❑ STREET ❑', 19227 138TH AVE SE CITY RENTON ST WA ZIP 980587772 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[ LDI IVEW # STATE WA SEX DDY
M M D.C.B.
01 20]_ 1958 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CDC7432 TAre WA vIN# WVGJNPE28NP038448
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE VOLK MODEL IDA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SEBASTIAN VITHAYATHIL 19227138THAVE SE RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. IU
9TOP
vE""LE CITATION# CHARGE o BOTTOMLEGALYYES Nu25❑ J
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED85541
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8555
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.
M.LEVERTON 07-26-23 02:43 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 8/2/2023 1:07.29 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED! 1:11 PM TIME POLICE ARRIVED',1:14 PM
PART I PAGE IT]OF 4�
REPORT NO. ED85541 CASE# 23-8555 OF COLLISION
07/26/23 13:02
OF CbLLI510N
NARRATIVE
outside It lane sb to eb slv/1 suv 2 wht suv
RTF
Within the city limits of Renton/King/WA I responded to a 2 car crash near Rainier Ave S at S 7th St.
I contacted the driver of unit 2 who told me he was stopped when he was hit from behind by unit 1.
He did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 who told me she just returned from a very long flight from Vietnam.
She said she was feeling sick and was leaving from work early to head home. She told me she was
in the outside left turn lane SIB to EB and accidently rolled forward into unit 2. Damages to her car
were unremarkable and did not require a tow truck.
Unit 1 declined to have Aid check her as he clutched her stomach most of the time and did not stand
well without some support from a fixed object.
Information/Insurance only
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 7/26/2023
PAGE 3 OF 4
REPORT NO. EU85541 CASE# 23-8555 DATE AND TIME 07/26/2313:02