HomeMy WebLinkAbout23-9230 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. ED88759 170
27
COLLISION REP FIT 1591971
CASE 23-9230 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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 08 - 11 - 2023 2242 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
OAKESDALEAVESW ST e✓
MILEPOST 4100
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S B W e SW41ST ST
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:7148780141 0 11
30
6� LAST NAME VAN FIRSTNAME NGUYEN MIDDLE H 1 1 2 31
INITIAL
STREET ❑, 973 S W 3RD PL CITY RENTON WA
NEW ADDRESS STjP', 98057 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 10 1- 07 - 1996 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CFU1198 sTArI WAVIN# JTHBK262695096304
10 F91 PI ATE i4
TRAILER STATE TRAILED STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 1 33
12 3 5 VIN#' VIN#
:.. FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 7 34
13 4 2009 LEXS IS SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 968882385 4
IN EFFECT &POLICY# 9TOP
VICLE CHARGE 1 5 36
LECALLvEH res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2063901247
16 a
LAST NAME NGUYEN FIRST NAME NATHAN MIDDLE
INITIAL
17 STREET❑ NEW ADDRESS❑' 16211 SE 140TH ST CITY RENTON ST WA ZIP 98059 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER # STATE WA SEX U MMDDW 11 14 2005 39
20❑ ON DUTY STATUS AIRBAG 5 RESTR 4 EJECT 1 H U EET NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CDV0407 TArE 41
WA VIN# 1HGCR2F34EA251221 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2014 MAKE HOND MODEL ACCORD STYLE 4D VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24 DAMAGE YES NO GENE MEYERS YES NO
REGISTERED OWNER INFO MENA NGUYEN 16211 SE 140TH ST RENTON WA 98059 D:2063837866 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 521 1800-1302-47AIN 1 9TOP 5
VEHICLE YES❑ N,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY
25 a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JASON JONES 11635 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED88759
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9230
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) PHAM ANDYB
(LAST FIRST,
ADDRESS&PHONE#
RENTON 2065937466 SEX i U MMDDYyry 09 - 18 - 2010
PASSENGER Z WITNESS 'UNIT# 2 SEA 7 AIRBAG 2 RESTR. q EJECT ? HELMET INJURY NATURE OF INJURIES
USE CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
Ex MMDDYYYV
PASSENGER ❑WITNESS UNIT# SEAT I 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'
On 8-11-23, at about 2244 hours, I was dispatched to a collision that occurred in the just south of the
intersection of Oakesdale AVE SW and SW 41 st ST.
I arrived and observed Unit 1 to have damage on the passenger side front door and fender and Unit 2
to damage to the front driver side.
I contacted the driver of Unit 1 who he stated he was not injured, nor did he need medical attention.
The driver of Unit 1 stated he was attempting to change lanes to allow him to make a right turn on to
SW 41 st ST from Oakesdale AVE SW. The driver of Unit 1 claimed Unit 2 was driving too fast
causing the collision.
I contacted the driver of Unit 2 who also claimed not to be injured, but was clear by Renton Fire due
to airbag deployment. The driver of Unit 2 stated he was driving south and was struck by Unit 2 when
they attempted to switch into their lane of travel.
A passenger in Unit 2 left the scene of the accident and was not contacted. The other passenger that
was in Unit 2 did not remember what happened and was uninjured.
I gave the driver of Unit 1 a verbal warning for inattention due to him not properly clearing a lane
before he changed lanes.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
JASON JONES 08-11-23 11:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 8/13/2023 12:44:17 PM
BADGE OR ID# 11635 OR]# WA0171300 TIME POLICE DISPATCHED 10:44 PM TIME POLICE ARRIVED 10:50 PM
PART Ei PAGE IT]OF
REPORT NO. ED88759 CASE# ' 23-9230 DATE AND TIME 08/11/23 22:42
OF COLLISION
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