HomeMy WebLinkAbout23-12709 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
CASE 23-12709 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 3 TOTAL#OF OBJECT 1 O 6 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 11 - 1-- 2023 1008 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MONSTER RD SW BLOCK NO. e✓ 651
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 400 00 FMILES EET e S ❑ W e MONSTER RD SW
0 5 29
MOTUNIT U1 VEHICR Z PEDAL-CLE CYCLE ElYESA,G/ENHORESHOLDMET PHONE 0 2 30
6� LAST NAME NGUYEN FIRSTNAME PHI MIDDLE T 1 1 2 31
INITIAL
STREET ❑, 14025 SE 158TH ST CITY RENTON ST WA ZIP' 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NOW INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H U EET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9❑ P1 aT�S� AOA4820 sTArI WAVrN# 5FNRt5H92E6009421
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# Rom ro
TRLR. TRLR 4 4 33
12 3 5 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 4 $ 34
13 2 2014 HOND ODYSSE VN DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO PHI NGUYEN 14025 SE 158TH ST RENTON WA 98058 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ABILITY INSURANCE INSURANCE CO GEICO 4442-57.76.82 4
IN EFFECTPOLICY# TOPvEBI LE CHARGE 36
LE—Lv re6 No clTAnoN# 3A0610833 PROHIBITEDUTURN <1�3
orrow
15❑ STANDING 7 6
MOTOR PEDAL- ❑ ❑:. PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE OWNER ❑ YES�/ NO D:2067735397
16 a
LAST NAME DIXON FIRST NAME DANIELLE MIDDLE IS
INITIAL
17 STREET❑ NEW ADOREss❑' 3711 S HOLLY ST CITY SEATTLE ST WA ZIP 98118 4❑ 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 DRIVER'S STATE WA ]SEX IF D.C... 08 _ 30 _ 2002 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 HEJ EET NJAURSY 1 NATURE OF INJURIES 40
LICENSE I ❑21❑ PLA E# CBM0908 TArE 41
WA vIN# 1GIZDSST5LF067347 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
TOWED BY Gov HI 44
VEH YEAR 2020 MAKE CHEV MODEL MALIBU STYLE $D —FEHICLE
TOWED NOO,/ BLIN YES
NO
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP 5
VEHICLE YES[:] NC[:] # 3A0610834 CHARGE OP MOT VEH W/OUT INSURANCE 10 ao-r-roM
GALLY
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
SEVEN FAJARILLO 12847 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE18319
COLLISION REPORT III III III III III 111
1591972 CASE# 23-12709
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 11-05-23 04:56 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 1111012023 11:25:34 AM
BADGE OR ID# ( 12847 OR]# WA0171300 TIME POLICE DISPATCHED; 10:09 AM TIME POLICE ARRIVED!10:18 AM
FART I PAGE IT]OF 4�
REPORT NO. EE18319 CASE# 23-12709 OF COLLISION
11/04/23 10:08
OF CbLLI510N
NARRATIVE
23-12709
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 11-04-2023 1 was working as a police officer in the city of Renton. At approximately 1008 hours I
was dispatched to the report of a collision at, 651 Monster Rd SW, 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, there was a two-vehicle collision with unknown injuries. Vehicle 1
was later identified as a white 2014 Honda Odyssey (WA/AOA4820). Vehicle 2 was later identified as
a blue 2020 Chevrolet Malibu (WA/CBM0908).
I arrived on scene and contacted the driver and lone occupant of Vehicle 2, Danielle S Dixon
(DOB:08-30-2002). Danielle told me she was driving west on Monster Rd SW when she noticed
Vehicle 1, also travelling west, slow down. Danielle was unsure of what Vehicle 1 was doing so she
moved left into the turn lane to overtake Vehicle 1. Before she could pass, Vehicle 1 took a left turn
and collided with her passenger front fender.
The driver of Vehicle 1, Phi T Nguyen (DOB:09-25-1969), had a 15-year-old female in the front seat
and a 12-year-old boy in the back seat. The children were uninjured and unidentified. Phi told a
similar story to Danielle. Phi said she slowed to make a U-Turn and when she started turning left, she
saw Vehicle 2 driving on the wrong side of the road. She could not avoid the collision.
All involved parties were evaluated by the fire department and cleared medically. Both vehicles were
towed privately. 1 photographed the scene and uploaded the pictures to Evidence.com.
Based on the information gathered during the investigation I believe Vehicle 1 made an illegal U-turn.
Vehicle 2 moved to the turn lane to avoid Vehicle 1 before it's U-turn.
I completed a notice of infraction #3A0610833 for RCW 46.61.295 Prohibited U Turn and mailed it to
Phi. I completed a notice of infraction #3A0610834 for RCW 46.30.020 Operating a Motor Vehicle
Without Insurance and mailed it to Danielle.
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 11/05/2023 @ 0845 hours in Renton WA.
PAGE 3 OF 4
REPORT NO.! EE18319 CASE# ' 23-12709 DATE AND TIME 11/04/23 10:08
OF COLLISION
Not to Scate
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PAGE 4 OF 4