HomeMy WebLinkAbout23-9383 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 23-9383 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;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# ❑
dowsloN 08 - 1-- 2023 2013 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S GRADY WAY BLOCK NO. e✓ 401
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 200 00 FEET MILES e S ❑ E e LAKEAVES
1 5 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES
NO ,/ D:2065737369 0 9 30
6� LAST NAME HUYNH FIRSTNAME JASON MIDDLE 1 2 31
INITIAL
STREET ❑ 8336 39TH AVE S CITY SEATTLE ST WA Zjp, 981184318 z=
NEW ADDRESS
❑ COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
7
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 aT�S� BZV9701 sTArr WAVIN# 1C46JWFG2FL555312
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 0 0 33
12 0 0 VIN#' VIN#'
FROM TO
VEH.YEAR MAKE JEEP MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 9 9 34
13 A 2015 WRANG DAMAGE YES NO YES[:] No
REGISTEREDOWNERINFO JASON HUYNH 8336 39TH AVE S SEATTLEWA98118 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO 2 3 4
LIABILITY INSURANCE
IN EFFECT &POLICY# � 9TOP 5
VEH CHARGE 1 BOTTOM 36
LEGALLY YES❑NO CITATION# 3A0588165,3A0588165 OP MOT VEH W/OUT INSURANCE,
15❑ NDING 8
MOTOR PEDAL- .PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑
16 a ❑ OWNPR ❑ YES 1/ No D:3055822802
LAST NAME BALAHOUTIS FIRST NAME ATHINA MIDDLE C
INITIAL
17❑ NEW ADDRESS❑' 461 TAYLOR PL NW CITY RENTON ST WA ZIP 98057 37
18❑ CDL ., IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYES — NO INTERLOCK YEs❑NOF YEs❑NOF,/
19 DCENSE# STATE FL SEX F MMODY
.B. 04 26 _ 1982 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# BXC8006 TArE 41
WA vIN1 3VWC576UOLM079563 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR 2020 MAKE VOLK MODEL JETTA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ATHINA BALAHOUTIS461 TAYLORPLNW RENTONWA 98057 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO pROGRESSIVE 944854839IN STOP 5
VEHICLE CITATION# CHARGE to BOTTOM
LEGALLY YES[Z NC[:]25❑ s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
JAREN JOKELA 12805 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. ED91204
COLLISION REPORT III III III III III 111
1591972 CASE# 23-9383
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) GUZMAN RAMOS JOSE
(LAST FIRST,
ADDRESS&PHONE#
461 TAYLOR PL NW RENTON WA 98057 3055822802 SEX M MMDOYyvv 06 - 02 - 1995
PASSENGER L,WITNESS R'UNIT# 2 PQS 3 AIRBAG 2 RESTR. 4 EJECT ? 1 H U SE 2 CLASS 1 NATURE OF INJURIES
NAME
(LAST,FIRST,MIDDLE INITIAL) CESPEDES ✓ULIAN D
ADDRESS&PHONE# D O B
461 TAYLOR PL NW RENTON WA 98057 SEX M MMDDYVvv 05 f 2 _ 2016
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER �WITNESS UNIT# 2 PGS 8 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.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.
JAREN JOKELA 08-16-23 12:33 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
G.BARFIELD 6476 1 812112023 1:25:07 AM
BADGE OR ID# 12805 OR]# WA0171300 TIME POLICE DISPATCHED 8:97 Pry TIME POLICE ARRIVED:8:27 Pry
PART I PAGE IT]OF 4�
REPORT NO. ED91204 CASE# 23-9383 OF COLLISION
08/15/23 20:13
OF CbLLI510N
NARRATIVE
RPD CASE#: 23-9383
On 08/15/2023 at approximately 2017 hours, I was dispatched to McDonalds, located at 401 S Grady
Way in the City of Renton, King County, Washington, for a non-injury non-blocking accident.
Upon arrival I located the vehicles in the East parking lot of McDonalds. I identified Unit 1 as a black
2015 Jeep Wrangler Unlimited, bearing WA license plate #BZV9701. Unit 1 sustained minor damage
to the left rear bumper.
I identified the driver of Unit 1 via his WADL as Jason Huynh (DOB 04/25/1975.) Huynh told me he
was not injured. I asked Huynh what happened, and he stated he was in the McDonalds parking lot
when he put his vehicle in reverse to park in the neighboring Applebee's parking lot. In reversing his
vehicle, he struck the right front bumper/hood of unit 2 that was behind him that was also stopped in
the McDonalds drive through line.
When I asked to see Huynh's insurance, he stated that he does not have valid insurance on the
vehicle.
I identified Unit 2 as a white Volkswagen Jetta, bearing WA license plate #BXC8006. Unit 2 sustained
damage to the front right bumper, headlight, and hood.
I identified the driver of Unit 2 via her FLDL as Athina C. Balahoutis (DOB 04/26/1982). Balahoutis
told me she was not injured. Two other occupants were also inside Unit 2 during the collision. A male
identified by his FLDL as Jose Guzman-Ramos (DOB 06/02/1995) was seated in the front right
passenger seat and a child, identified by his mother as Julian D. Cespedes (DOB 05/12/2016), was in
the center rear seat. Both passengers stated they were uninjured.
I asked Balahoutis what happened, and she stated she was stopped in the McDonalds drive through
line when Unit 1 put his vehicle in reverse and backed up into her car.
I provided both parties with my business card with the case number on it and answered their
questions. I advised Huynh he was the at fault party and he would receive a citation in the mail for
inattention and for operating a motor vehicle without insurance.
I then cleared the scene.
This ends 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 J. Jokela on 08/02/2023 at 2301 hours, in the City of Renton, WA.
PAGE 3 OF 4
REPORT NO. ED91204 CASE# ' 23-9383 DATE AND TIME 08/15/23 20:13
OF COLLISION
Q
Unit
Q
� J
Not To Scale
PAGE 4 OF 4