HomeMy WebLinkAbout23-12471 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12471 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I 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#
cawsloN 10 - 1-- 2023 1807 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e S 3RD ST
2 0 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD MET PHONE 0 1 30
6� LAST NAME NGUYEN FIRSTNAME THI MIDDLE T 1 2 31
INITIAL
STREET ❑, 13000 MARTIN LUTHER KING JR W TRLR 7 CITY SEATTLE ST WA ZIP, 981784652 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO 1/ I INTERLOCK YES NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 1❑ p7 ATE 14 AUH7960 STATE WA u N# JTDBL40E69J007867
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 5 7 33
12 3 5 VIN#j VIN#'
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 ] 34
13 2 2009 TOYT COROL 4D DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO KIM NGUYEN 13000 MARTIN LUTHER KING JR W SEATTLE WA 98178 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
2 INSURANCE CO 3 4
14 LIABILITY INSURANCE STATE FARM 488 3882-E01.47
IN EFFECT &POLICY# � 9TOP
VEHICLe CHARGE 36
LE—Lft res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
�NiT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2063722427
16 a
LAST NAME LADD FIRST NAME SHERESE MIDDLE L
INITIAL
17 STREET❑ NEW ADOREss❑' 23611 106TH AVE SE CITY KENT ST WA ZIP 980313352 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 D IVEW # STATE WA SEX F Mr D.C.B. 03 _ 10 _ 1991 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES ❑ 40
USE CLASS C/O
❑
21❑ LICENSE 1 PLA E# CHR0623 TATE WA VIN# USE
BACK PAIN 41
1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
GI
VEH YEAR 2015 MAKE GMC MODEL yUKON STYLE $V DAMAGE TOWED NOO✓ BLIN TOWED BY ov HYES NO 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE 8 POINSURGY#E CO pROFRESSIVE 965683618IN STOP 5
VE""LE ❑ Nu,J CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES s � e
=UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE15387
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12471
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DADE GLOR/A J
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
23611 106TH AVE SE KENT WA 98031 2063131537 SEXi F MMDOYyry 08 - 31 - 1958
{� SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 2 POS. 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS '7 ..O K STIFFNESS
NAME
(LAST,FIRST,MIDDLE INITIAL) LADD LAUREN L
ADDRESS&PHONE# DOB
23611 106TH AVE SE KENT WA 98031 SEX: F MMDovvvv 10 _ 03 _ 2012
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 7 C/O GENERAL PAIN
NAME
(LAST FIR57 MIDDLE INITIAL)
ADDRESS R PHONE#
SEX D.O.B.
MMDDYYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS T�----�
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.
MATTHEW NUGENT 10-31-23 04:00 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 11/1/2023 2:41:07 PM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 8:09 Pry TIME POLICE ARRIVED',6:10 PM
PART I PAGE IT]OF 4]
REPORT NO. EE15387 CASE# 23-12471 OF COLLISION
10/30/23 18:07
OF CbLLI510N
NARRATIVE
23-12471
On 10/30/2023 at approximately 1813 hours, I was dispatched to a non-injury and blocking vehicle
collision in the 300 block of Rainier Ave South, within the City Limits of Renton, County of King, State
of Washington.
Dispatch advised of a 2-vehicle collision. Sergeant J. Trader and Officer R. Gorajewski had arrived on
scene prior to me and were able to have the involved vehicles pull off the roadway and into a nearby
parking lot. Upon arrival, I contacted the involved parties and determined no injuries requiring
immediate medical attention had occurred as a result of the collision. The driver and two of the five
passengers of Unit#2 complained of being shaken up but declined aid response at the time of report.
I collected each involved parties driving information and their independent recollection of the incident.
The driver of Unit#1 said she was the sole occupant of her vehicle and was traveling northbound in
about the 300 block of Rainier Ave S approaching the intersection of SW Sunset Blvd (a.k.a. S 3rd St)
in lane 2 of 4. The driver of Unit#1 stated that she needed to make a westbound turn onto SW
Sunset Blvd and was attempting to move over into lane 3 of 4 as she was in the incorrect lane. Unit
#1 stated that while stopped, Unit#2 made contact with the rear of Unit#1 causing minor damage.
The driver of Unit#1 denied ever putting her vehicle in reverse.
The driver of Unit#2 said she and fiver passengers (1 adult, 4 juveniles) were also traveling
northbound in about the 300 block of Rainier Ave S approaching the intersection of SW Sunset Blvd
(a.k.a. S 3rd St) in lane 2 of 4. The driver of Unit#2 stated she came to a stop for traffic queued at the
intersection even though her direction of travel had a green light. The driver of Unit#2 stated that
while stopped, Unit#1 reversed her vehicle into the front of Unit#2 causing minor damage.
Based on the above statements, I determined that the Driver of Unit#1 (Nguyen) was the
predominant factor for the collision due to obstructing traffic by being in the improper lane causing a
collision.
Both Unit#1 and Unit#2 were able to be driven away without further incident. An exchange of
information was provided to all involved parties.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed by Officer M. Nugent#11498 10/31/2023 3:56 PM Renton, King County, WA.
PAGE 3 OF 4
REPORT NO.! EE15387 CASE# ' 23-12471 DATE AND TIME 10/30/23 18:07
OF COLLISION
N
SW Sunset Bled
S3S`t
Unit#2 ' D"
CD
PAGE 4 OF 4