HomeMy WebLinkAbout23-8696 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-8696 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER � VFHIC;I F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 8 2$
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 1249 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S 3RD ST BLOCK e✓ 200
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 250 00 FMILES EET e S ❑ E e RAINIER AVE S
0 2 29
MOTU '�01 VEHtOCLEZ PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 1 3 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY RENTON ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
DRIVERS
STATE SEX D - 328 LICENSE MDYY❑ M
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
10� PI ATNE 14 76GQR sTATe FL v N# 1FM5K8GT2DGB97485
TRAILER STATE TRAILER STATE
11 1 PLATE# PLATE# IR.. ro
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 A 2013 FORD EXPLOR SIP DAMAGE YES NO YES❑ NO
REGISTERED.WNERWFO ENRIQUE SANCHEZ 4135 REGATA WAY APT 107 FORT MYERS FL 33916 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ ABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT l POLICY# 9TOP
VEIF" CHARGE 1 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:4252600882
16❑
LAST NAME TRUONG FIRST NAME BICH MIDDLE I D
INITIAL
17 NEW STREETR 7' 13910 SE 156TH ST CITY' RENTON ST WA ZIP 980587819 37
18� CDL IGNITION REQUIRED IGNITION PR-E-S1ENT MEDICAL t-T�RANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YES It I NoF t YES l NO�
19 D IVERI #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 9 CLASS 1 ❑
❑ILICENSE 21❑ PLA E# ARZ5664 TATe 41
WA VIN# JHLRE48528C012230 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2008 MAKE HOND MODEL CR-V STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO LOC PHAN 16577 SE 162ND ST RENTON WA 98058 D:4252600882 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO CONNECT AX01016961IN 1 VEHICLE ❑ ,.II CITATION# CHARGE �,�
LEGALLY YES N
25 Q.
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TAGNE 12575 WA0171300
PART A PAGE 01 OF C7
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED84871
COLLISION REPORT III III III III III 111
1591972 CASE# 23-8696
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'
23-8696
On 07/30/2023 at approximately 1249 hours, I, Officer Lantagne, responded to a non-blocking, non-
injury collision which occurred at the fuel pumps of the Safeway, 200 S 3rd ST, which is located in the
City of Renton, County of King, and the State of Washington. I responded in my fully marked police
vehicle, wearing my patrol uniform.
I arrived on scene and observed Unit#2, a 2008 Honda CR-V with license plates ARZ5664 issued
out of Washington State, parked at the south fuel pumps. I was advised by the driver of Unit#2, Bich
D. Truong (DOB 08/28/1960), there were no injuries.
Truong told me the following: Truong's vehicle was parked at the fuel pumps. As Truong was legally
parked and waiting, the front bumper of Unit#1, a red Ford Explorer with license plates 76GQR
issued out of Florida State, struck the left rear bumper of Truong's vehicle. The male driver of unit#2
was yelling at Truong from his window about her parking him in and then he drove away.
I observed the damage to the vehicle and other physical evidence was consistent with the statements
made by Truong. Unit#2 had very minor damage to the left rear bumper which consisted of a small
scrape and red paint transfer.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Truong. I advised Truong based off of the damage, it was
probable that the other driver did not feel the collision.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1505 hours on 07/30/2023 at Renton, WA.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
P.LANTAGNE 07-30-23 03:07 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 713112023 6:24:30 PM
BADGE OR ID# 12575 ORI#' WA0171300 TIME POLICE DISPATCHED! 12:54 PM TIME POLICE ARRIVED';12:54 PM
PART I PAGE IT]OF
REPORT NO. ED84871 CASE# ' 23-8696 DATE AND TIME 07/30/23 12:49
OF COLLISION
uuuuuuuuiuuuuuuuu uuuuuuuuiuuuuuuuu uuu ,\\\\\\\ , ' I I
My.MY� I
& vL�
S Sf Gaye#23-86gE Unit#1 Unit#2
N
Rainier Ave S` Not to Scale
P.l antagne#12575
PAGE 3 OF 3