HomeMy WebLinkAbout23-14451 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE35795 170
27
COLLISION REP FIT 1591971
CASE 23-14451 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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 12 - 1-- 2023 2240 17 ❑.❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ Y800
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES❑ 50 00 FEET e S ❑ W e NE 10TH ST
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:2065781548 0 11
30
6 LAST NAME PAEZ GARITA FIRST NAME MIGUEL MIDDLE N 1 1 2 31
INITIAL
STREET ❑, 18635 SE 128TH ST CITY RENTON ST WA ZIP 980598726 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO,/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
LICENSE CER3122 sTATe WA urN# 5XXGT4L34GG087316
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 0 PLATE# PLATE# FROM TO
TRLR. TRLR 5 1 33
12 3 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 2016 KIA OPTIMA SD DAMAGE YES NO YYES[:] No✓
REGISTERED OWNER INFO JOSE RIVERA RIVERA 3002 S 208TH STD8 SEATAC WA 98188 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE❑ INSURANCE CO NONE 3 4
IN EFFECT &POLICY# 9TOP
vHICLe CHARGE 1 5 36
15❑
LEEGALLv YES�No D CITATION# 3A0840000, IMPROPER LANE USAGE, )o eorrom
STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES,/
16 NO D:2068188198
a
LAST NAME NGUYEN FIRST NAME TRANG MIDDLE N
INITIAL
17❑ STREET ❑', 1201 ANACORTES AV NE B301 CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NoF,/
19 DRIVER'S STATE WA SEX F D.C.B. 09 _ 10 _ 1985 0 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CHP7296 TATe WA VIN# 3MW89FF04P8D57620
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2023 MAKE BMW MODEL 330X1 STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO SIXT TITLING TRUST 1501 NW49TH STSTE 100 FORTLAUDERDALE FL 33309 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#ECO RSF5185385-03 EMPIRE FIRE AND MARINE I STOP 5
IN EFFECT
"'LE ❑ ,.I— CITATION# CHARGE i o BOTTOM
LEGALLY YES N`LJ
25 Q.
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
HANSEN HSU 12651 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE35795
COLLISION REPORT III III III III III 111
1591972 CASE# 23-14451
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(IAST FIRST,MIDDLE INITIAL) PHAM HAI
ADDRESS&PHONE# D O.B. '
16 ASH ST GARDNER MA 01440 9784136360 SEX M MMDDYyry 06 - 22 - 1987
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)
ADDRESS&PHONE# D O B
EX IMMDDYYYYI I-
T
PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY
POS. NATURE OF INJURIES
USE CLASS
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'
Both Units 1 and 2 traveling north along the 2800 block of NE Sunset Blvd approaching NE 10th St.
Unit 1 driver makes unsafe lane change and veers into Unit 2's lane causing non reportable non
disabling front passenger side damage to Unit 1 and reportable non disabling damage to the rear
driver side of Unit 2. No injuries. Unit 1 driver reportedly panicked and continued driving with Unit 2 in
tow until both units stopped at 1045 Chelan Av NE. Unit 1 driver with valid driver license. No PC for
impairment or hit and run attended. Unit 1 driver cited for unsafe lane change, no vehicle registration,
and no proof of valid vehicle insurance.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
HANSEN HSU 12-17-23 12:01 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 12/31/2023 1:06:00 AM
BADGE OR ID# 12651 ORI#' WA0171300 TIME POLICE DISPATCHED' 10:54 PM TIME POLICE ARRIVED 10:59 PM
PART I PAGE 2�OF❑
REPORT NO. EE35795 CASE# 23-14451 DATE AND TIME 12/16/23 22:40
OF COLLISION
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