HomeMy WebLinkAbout23-12857 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 23-12857 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 0 4 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
CawsloN 11 - 08 - 2023 0619 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 130TH ST BLOCK NO. e✓ 8000 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e BOTH AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2069921776 0 11
30
6� LAST NAME KWAN FIRSTNAME WAI MIDDLE L 1 2 31
INITIAL
STREET ❑ 12853 80TH AVE S CITY SEA FT ST WA ZIP 98178 z
NEW ADDRESS II
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ DRIVERS
E#
ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 . EJECT 1 H LMI I INJURY [NATURE OF IN
U EET CLASS ju HEAD PAIN JURIES z❑
3
10 9❑ P1 ATE 14 500WQE STATE WA VIN# JTHBN36F740142535
TRAILER STATE TRAILED STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 1 5 33
12 3 5 VIN#' VIN#
:.. FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 $ 34
13 2 2004 LEXS LS SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14❑ LIABILITY INSURANCE IN
CO AMERICAN FAMILY 1906-1102.02.62-FFPA-WA 3
IN EFFECT &POLICY# 9TOP
36
VEHICLE CHARGE 5❑NO❑ CITATION# 10 BOTTOM
15❑ LEGALLY STANDING YES 8 7 6
UNIT 02 VE ICCLE CYCLE ❑ PEDESTRIAN ❑ OWNERRTY ❑ DYES NO SOLD MET PHONE
16 a
LAST NAME UNKNOWN FIRST NAME MIDDLE
INITIAL
STREET CITY SEATTLE ST ZIP 4
17❑ NEW ADDRESS❑ ❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 LLIICENS RIVERIS# STATE SEX U MMDDYY —❑_ 39
WELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG g RESTR 9 EJECT '1 USE 9 CLASS 0 ❑
❑21❑ LICENSE TATE VIN# 41
1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN It IN#.
VEH YEAR MAKE JEEP MODEL UNKNOW STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO%/ YES NO
REGISTERED OWNER INFO UNKNOWN SEATTLE VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
LEGALLY YES N`LJ
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
STEVEN FAJARILLO 12847 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE18320
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12857
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.
STEVEN FAJARILLO 11-08-23 07:48 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 1111012023 11:25:28 AM
BADGE OR ID# 12847 OR]# WA0171300 TIME POLICE DISPATCHED 6:20 AM TIME POLICE ARRIVED 6:23 AM
FART I PAGE IT]OF 4]
REPORT NO. EE18320 CASE# 23-12857 OF COLLISION
11/08/23 06:19
OF CbLLI510N
NARRATIVE
23-12857
This incident was captured on my body worn video camera. This report is a summary of events that
occurred and is not an exact sequencing of events. Statements have been paraphrased and
summarized.
On 11-08-2023 1 was working as a police officer in the city of Renton. At approximately 0620 hours I
was dispatched to the report of an injury collision at the intersection of S 130th St/80th Ave S, City of
Renton, County of King, WA. This incident was captured on my department issued Axon body
camera.
According to the notes in the call, in the intersection there was a two-vehicle motor vehicle collision.
One of the involved parties complained of head pain. A silver Jeep was gone from the scene.
I arrived on scene and contacted Wai L Kwan (DOB:06-21-1964). He was driving Vehicle 1, a silver
2004 Lexus LS (WA/500WQE). He was the lone occupant in the vehicle. He was stopped at the stop
sign facing south on 80th Ave S. He did not see any vehicles or headlights, so he proceeded south
through the intersection. He collided with Vehicle 2, a silver Jeep. There was unknown make, model,
or license plate. Vehicle 2 was travelling east on S 130th St. There was damage to Vehicle 1's rear
passenger side bumper.
The driver of Vehicle 2 exited the vehicle for a moment and then left the scene west on S 130th St
without exchanging information. The driver of Vehicle 2 was described as a middle age, white male,
with light colored hair. There was nothing on scene of evidentiary value.
Wai was cleared medically by the fire department. His vehicle was still drivable. I photographed his
vehicle damage and uploaded the pictures to Evidence.com. I provided Wai with a case number.
According to the facts regarding this case, there was not enough information to establish probable
cause for a suspect in this hit and run.
There is no further information available at this time.
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 S. Fajarillo #12847 on 11/08/2023 @ 0745 hours in Renton WA.
PAGE 3 OF 4
REPORT NO.! EE18320 CASE# ' 23-12857 DATE AND TIME 11/08/23 06:19
OF COLLISION
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