HomeMy WebLinkAbout23-9220 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-9220 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 6 0 28
TRIBAL UNITS 02 STRUCK NONE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
CowsloN 08 - 11 - 2023 1455 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 8TH ST BLOCK e✓ 800 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e LOGAN AVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4252696386 0 11
30
6❑ LAST NAME CHIN FIRSTNAME TAMAI MIDDLE Y 1 2 31
INITIAL
STREET ❑ 2103 BREMERTON AVE NE CITY RENTON ST WA ZIP 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 11 1- 17 - 1964 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET 2 CLASS 1 NATURE OF INJURIES z❑
3
,OF
PI ATE 14 AMG6481 JBTATIJ WA u N# 4T18F18B7XU337170
TRAILER STATE TRAILED STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 2 5 VIN#' VIN#
>;. FROM TO
❑ VEH.YEAR1999 TOYT AVALON SD MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED By I GOVT.VEHICLE 1 7 3 34
13 4 DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� INEFITYINSURANCE� INSURANCECOSTATEFARM4732206B25.47 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2133722426
16 a
LAST NAME VUILLEUMIER FIRST NAME SCOTT MIDDLE IS
INITIAL
17❑ STREET ❑' 3717 CALIFORINA AVE SW CITY SEATTLE ST WA ZIP 98116 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LICENSE# STATE WA SEX M MMDDW 04 08 _ 1989 0 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE I CCL0649 TAre WA vIN# JF1SG63686H736305
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
GI
VEH YEAR 2006 MAKE S(JB�Q MODEL FORESTE STYLE GA DAMAGE TOWED NOO✓ BLIN TOWED BY ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO GEIC04518-60-46-75IN I 9TOP
VEHICLE YES[:] N C[:] CITATION# CHARGE i o BOTTOM
LEGALLY
25 $
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
SULIASI TAMAIVENA 12788 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88768
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9220
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.
SULIASI TAMA/VENA 08-13-23 09:02 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 8/13/2023 12:45:11 PM
BADGE OR ID# 1Y788 ORI#` WA0171300 TIME POLICE DISPATCHED 3:09 PM TIME POLICE ARRIVED',3:50 PM
PART Ei PAGE IT]OF 4�
TIME
REPORT NO. ED88768 CASE# 23-9220 OF COLLISION08/11/23 14:55
NARRATIVE
23-9220
On 08/12/2023 at approximately 1509 hours, I was dispatched to a car accident at N 8th ST and
Logan Ave N intersection, within the city limits of Renton, King County, WA State. According to the
dispatch notes, the vehicles have more than $1000 in damages between a silver Subaru and a white
Toyota Avalon. Dispatch also advised that both drivers pulled into a parking lot at N 8th ST near
Carhart and LA Fitness and will be waiting to be contacted by police.
I arrived on scene and observed Vehicle #1, a white Toyota Avalon (WA Plate# F241688), that had
damages to the front bumper, headlights, and the front hood of the vehicle. I also observed minor
scratch marks on the back bumper of Vehicle #2, a silver Subaru Forester (WA Plate# F290351).
Both cars could still operate and drive, and both drivers claimed no injuries.
The driver of Vehicle 1#, who identified with a WADL as Tami Y. Chin (DOB 11/17/1964), stated she
was traveling east on N 8th ST and was behind Driver#2. Chin advised that when she saw the traffic
light turn green, she and Driver#2 proceeded to drive forward. As she continued to drive forward, she
was unaware that Driver#2 had stopped, which caused her to rear-end Vehicle #2.
1 spoke with Driver#2, who identified with a WADL as Scott S. Vulleumier (DOB 01/06/1989), and he
stated he was traveling east on N 8th ST. Vulleumier stated that while driving forward, he claimed to
see a stop sign and stopped his vehicle. He advised that when he stopped and Vehicle #1 rear-ended
him.
I later went to the accident scene and observed that the intersection was controlled by a traffic light.
There was a pedestrian crossing sign located at the intersection facing NE 8th St. The pedestrian
crossing sign had a picture of a stop sign built into it. It is unknown if this is what Vulleumier observed
when he referred to seeing a stop sign.
It is unclear if Vehicle #1 was following too closely to Vehicle #2 or if Vehicle #2 stopped at a green
light due to observing a stop sign.
I provided both Drivers with a case number for this incident and ended my contact with them.
This concludes my report.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by S. Tamaivena #12788 on 08/13/2023 @0719 hours in Renton, WA
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Traffic Control: GREEN LIGHT
Motor Vehicle Unit 2
Traffic Control: GREEN LIGHT
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. ED88768 CASE# ' 23-9220 DATE AND TIME 08/11/23 14:55
OF COLLISION
N
Vehicle#2
N 8th St.
Vehicle#
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