HomeMy WebLinkAbout23-11878 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-11878 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHI1.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 10 - 1-- 2023 1721 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE CARR ROAD BLOCK NO. e✓ 10600
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 150 00 FMILES EET e S ❑ W e 108THAVENUE SE
0 4 29
R PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YES ✓NO D:2039120570 2 01
30
6� LAST NAME NIGUIDULA FIRSTNAME WAN MIDDLE W 1 1 2 31
INITIAL
STREET ❑, 611 SOUTH 53RD PLACE C{Ty RENTON ST WA 2jp, 98055 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE SS ICNLJU:SY 0 NATURE OF INJURIES z❑
3
10 1❑ Pi ATNES# CCV9720 sTAr WAu N# 4T38A3BBXFU066940
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
FT -R TPILF1 1 3 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR 2015 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 9 3 TOWED BY GOVT.VEHICLE 34
13 4 TOYT VENZA UT DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO ANGELICA EUROPA 611 SOUTH 53RD PLACE RENTON WA 98055 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO GEICO 6101928890 3 4
IN EFFECT &POLICY# 9TOP
VE—L' CHARGE 1 5 36
LEGALLY, YES❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDIN 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254425585
16 a
LAST NAME CHUANG FIRST NAME ROSALIND MIDDLE
INITIAL
17❑ STREET ❑', 16416 116TH PL SE CITY' RENTON ST WA ZIP 98058 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL t-T�RANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YES I I No� YES t l NO❑
11
19 LDICENS STATE WA ]SEX IF M .C... 09 _ 08 _ 1993 El 39
HELMET {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE I B668068 TAre WA VIN1i 4S3BNAA6XG3061254
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2016 MAKE SUBA MODEL LEGACY STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO ROSALIND CHUANG 16416116TH PL SE RENTON WA 98058 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO ALLSTATE 817-391-445IN 1 VEHICLE ❑ C[:] CITATION# CHARGE
25 UQ,
LEGALLY YES N
7ESAGIAO
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
10339 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE10990
COLLISION REPORT III III III III III 111
1591972 CASE# 23-11878
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.
E.SAGIAO 10-17-23 07:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIRES SCOTT 10272 1 1011912023 4:47:26 PM
BADGE OR ID# 10339 OR]# WA0171300 TIME POLICE DISPATCHED 5:36 PM TIME POLICE ARRIVED',5:37 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EE10990 CASE# 23-11878 OF COLLISION
10/17/23 17:21
OF CbLLI510N
NARRATIVE
On 10-17-23 at 1736 hours I was dispatched to a collision in the 10600 block of SE Carr Road, in the
City of Renton, King County, State of Washington. I had later called the reporting party who advised
both parties had stopped into the parking lot of a local business nearby.
I contacted Unit#2 driver identified by WA DL as Rosalind Chuang. Unit#2 was a gray 2016 Subaru
Legacy (WA-BBB8068). Chuang is the registered owner. Chuang advised me she was traffic on SE
Carr Road facing eastbound. There was heavy traffic, and she had the front of her vehicle stopped in
the left turn to go northbound on Benson Drive/108th Avenue SE. She advised when the light turned
green, she continued to merge into the lane and Unit#1 struck her from a private driveway.
Damage to Unit#2 was to the front driver side consistent with Chuang's account.
Unit#2 was a silver 2015 Toyota Venza (WA-CCV9720). The driver was identified by WA DL as
Brian Niguidula. He advised he was pulling out of the CVS parking lot to enter the turn/middle lane of
traffic and head eastbound. He relayed he did not see Unit#2 and that the lane was clear. Damage to
Unit#1 was consistent with his account and was to the front passenger side.
No injuries were reported on scene. Neither vehicle was towed. Both drivers were provided a
business card with this case number. Unit#1 is at fault driver for inattention and granting the right of
way to Unit#2 who was already situated on the road. No citation was issued.
The incident was captured on my body worn camera. The report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
I certify or declare under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
E.Sagiao/10339
PAGE 3 OF 4
REPORT NO.! EE10990 CASE# ' 23-11878 DATE AND TIME 10/17/23 17:21
OF COLLISION
N`
Private Drive
108th,Avenue SE
SE Carr Road SE Petrovitsky Road
108th Avenue SE
PAGE 4 OF 4