HomeMy WebLinkAbout23-12658 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-12658 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# ❑
cawsloN 11 - 1-- 2023 0932 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
TALBOT RD S BLOCK NO. e✓ 1400
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 5001. 00 FEET MILES e S B W e S PUGET DR
0 3 29
UNIT MOTOR
VEHICL Z CYCLE ElDDAMYESA✓THRESHOLD MET PHONE 0 1 30
6� LAST NAME PHAM FIRSTNAME NGUYEN MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 351 MT BAKER PL NE CITY RENTON ST WA ZIP 980594890 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATE 14 BV22461 STATE WA u N# 2T3DWRFV4LW070852
11[-j- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# IR.. ro
TRLR. TRLR. 5 3 33
12 3 5 VIN#j VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 3 34
13 2 2020 TOYT RAV4 DAMAGE YES NO ✓ YES[:] No✓
REGISTERED OWNER INFO NGUYENPHAM 4116 NE 5TH ST RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14LIABILITY INSURANCE INSURANCE CO ST FARM 501.6631-D15.47A 3
IN EFFECT &POLICY# 9TOP
vewcLe CHARGE 1 5 36
LEGALLY YEs❑NO CITATION# 3A0681721 PROH/IMPROPER TURN o aorrom
El
15❑ 1ND'ING 8 7 6
MOTUNIT VE IDOLS CYCLE ❑ PEDESTRIAN ❑ PROPERTY ❑ DYES✓ NO OLD MET PHONE
16 a
LAST NAME SHAHZAD FIRST NAME MUQEET MIDDLE
INITIAL
17❑ STREET ❑', 372 HARBOR RD CITY STATEN ISLAND ST NY ZIP 103030000 37
NEW ADDRE I I I I I i ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 DRIVER'S STATE NY SEX M D.Q.B. 07 11 2001 0 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE 822Y13 TATe NV VIN1 3FA6POLU7LR226440
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE FORD MODEL FUSION STYLE VEHICLE TOWED TO BLIN TOWED eY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO✓
REGISTERED OWNER INFO FAIZAL KHOJA 5175 JERRY TARKANIAN WAY UNIT LAS VEGAS NV891480005 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE INSU&POLICY#E CO SAME. 9TOP 5
VEwGLE ❑ ,J CITATION# CHARGE
YES
25 io BOTTOM
LEGALLY Nu
' 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE20365
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12658
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
POS. 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.
M.LEVERTON 11-03-23 10:33 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CO.JOHNSON 0505 1 1111612023 3:38:31 PM
BADGE OR ID# 2517 ORI# WA0171300 TIME POLICE DISPATCHED 9:32 AM TIME POLICE ARRIVED',9:37 AM
PART I PAGE IT]OF 4�
REPORT NO. EE20365 CASE# 23-12658 OF COLLISION
11/03/23 09:32
OF CbLLI510N
NARRATIVE
wht sedan nb In 1 gry suv It
CC
Within the city limits of Renton/King/Wa I responded to a 2 car blocking crash at the 1400 block of
Talbot Rd S.
I contacted the driver of unit 2 who told me he was in lane 1 northbound Talbot when unit 1 turned
across his path, causing his car significant damage and coming to rest on a traffic island. He did not
complain of injury and damages did require a tow truck.
I contacted the driver of unit 1 ID'd by his picture WADL who told me he was in lane 2 northbound and
made a right turn across lane one into the side of unit 2. He was turning into the parking lot of 1400
Talbot Rd S. He did not complain of injury and damages did not require a tow truck.
I cited unit 1 ref RCW 46.61.290 Fail to make right turn from furthest right lane 2 car crash via
complaint.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 11/3/2023
PAGE 3 OF 4
REPORT NO. EE20365 CASE# ' 23-12658 DATE AND TIME 11/03/23 09:32
OF COLLISION
lock
nts
PAGE 4 OF 4