HomeMy WebLinkAbout23-8638 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-8638 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I 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 07 - 1-- 2023 1732 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
SW SUNSET BLVD BLOCK MILEPOST ST e✓ 100 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ OF HARDIEAVESW
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254665239 0 11
30
6 LAST NAME HO FIRSTNAME SUE-MAY MIDDLE E 1 1 2 31
INITIAL
STREET ❑ 8043 S 116TH ST CITY SEATTLE ST WA ZIP 98178 z
NEW ADDRESS
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 2❑
3
10 1❑ PI ATE 14 CDV7485 sTAT WA VIN#
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
rRLR. TRLR. 5 3 33
12 2 5 VIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 5 1 34
13 4 2018 TOYT CAMRY SD DAMAGE YES NO � �MYERS Yes❑ No
REGISTERED OWNER INFO SUE-MAY HO 8043 S 116TH ST SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO LIBERTY MUTUAL AOS-261.928438.7024 3 4
IN EFFECT &POLICY# 9TOP
vEHICLE CHARGE 5 36
-ALLv YES No CITATION 3AO531525 INATTENTION oeorrom
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2063353179
16 2
LAST NAME LEWIS FIRST NAME LLOYD MIDDLE A
INITIAL
17❑ STREET ❑', 12032 64TH PL S CITY SEATTLE ST WA ZIP 98178 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 IVER # STATE WA SEX M M .C... 12 _ 04 1951 El 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET INJURY 6 NATURE OF INJURIES ❑ 40
USE CLASS IMPACT
21❑ LICENSE I BK63026 TATE WA VIN# KNMAT2MT1JP513309
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2018 MAKE NIS5 MODEL ROGUE STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES✓ NO GENE MYERS YES NO
REGISTERED OWNER INFO LLOYD LEWIS 1203264THPL S SEATTLE WA 98178 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU PORGY#ECO STATE FARM 430-8614-C19-47IN 9TOP 5
vEGA— ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N`[J
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.SAG/AO 10339 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84874
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8638
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GUMIRAN THERESITA S
(IAST FIRST,
ADDRESS&PHONE#
12032 64TH P!S SEATTLE WA 98178 2063353179 SEXi F MMDOYyvv 05 - O6 - 1953
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS, 3 2 4 1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) LEWIS JEDRICK J
ADDRESS&PHONE# D O E4
12032 64TH P!S SEATTLE WA 98178 2063353179 SEX: M MMODvvvv 05 f 3 _ 1996
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑ UNIT# 2 POS 7 AIRBAG 2 RESTR. 4 EJECT 1 USE CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
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.
E.SAGIAO 07-28-23 07:35 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:24:43 PM
BADGE OR ID# 10339 OR]# WA0171300 TIME POLICE DISPATCHED 5:35 PM TIME POLICE ARRIVED',5:46 PM
PART Ei PAGE IT]OF 4�
REPORT NO. ED84874 CASE# 23-8638 OF COLLISION
07/28/23 17:32
OF CbLLI510N
NARRATIVE
On 7-28-23 at 1735 hours I was dispatched to a collision at the intersection of SW Sunset Boulevard
and Hardie Avenue SW, in the City of Renton, King County, State of Washington.
I arrived and contacted Unit#1 which was a white 2018 Toyota Camry (WA-CDV7485) registered to
a Sue-May E. Ho. The driver of the vehicle was Ho who I identified by her WA DL. Ho told me she
traveled southbound on Hardie Avenue SW and was attempting a left turn to head east on SW
Sunset Blvd when the collision occurred. Ho seemed confused and RFA was called to evaluate
passengers and drivers.
Ho's vehicle had damage to front passenger side and the front passenger side tire was titled in. I
requested a tow. Gene Myers responded. Her vehicle was situated at an angle towards SW Sunset
Boulevard as if she as making a left as she informed me.
Unit#1 was a gray 2018 Nissan Rogue (WA-BKB3026) registered to a Lloyd Ace Lewis. I identified
Lewis as the driver of Unit#2 by his WA DL. Lewis told me he had a green light and proceeded
through the intersection when Unit#1 struck his vehicle. The damage to Unit#2 was to the front of
the vehicle and consistent with his account of what occurred.
RFA arrived and evaluated the involved parties. Two Gene Myers tow arrived as both vehicles were
unable to be driven. I provided both parties a business card with this case number and advised them
of the telephone number for the records division to request a copy of this report.
I advised Ho she would receive a citation in the mail for failure to yield which I amended to inattention
since it appeared Ho was confused on who exactly had the right of way. This intersection is unique
because of the addition of Langston Avenue to the intersection. Both drivers confirmed their mailing
addresses to me on scene. See collision report for more details.
The incident was captured on by body worn camera. The report is a summary of events that occurred
and is not an exact sequencing of events. Statements have been paraphrased and summarized.
I certify or declare under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
E.Sagiao/10339
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: LEFT TURN
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. ED84874 CASE# ' 23-8638 DATE AND TIME 07/28/23 17:32
OF COLLISION
SW Sunset Bond
�9 n9ston
Hardie Ave SW
Hardie Aver SW
SW Sunset Blvd
PAGE 4 OF 4