HomeMy WebLinkAbout23-13081 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13081 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#
cowsloN 11 - 1-- 2023 1308 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RENTON AVE SOUTH BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ MILE N❑ FEET e S ❑ E e SW VICTORIA ST
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:3475537152 0 11
30
LAST NAME HERRERA GALBAN FIRST NAME ADRIAN MIDDLE A
6 INITIAL 1 2 31
STREET ❑ 2305 116TH ST SW CITY EVERETT ST WA ZIP 98204 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8 LRIIVERCENS # STATE SEX'M MDMDD 12 - 29 - 1987 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET U E 2 CLASRuY 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� A6643283 sTArI WAurN# ZFBCFXATOGP344655
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 7 4 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 2016 FIAT 500 POP 2H DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14� LIABILI INSURANCE INSURANCE CO LOBEL FINANCIAL 7149953333/503-653.3162
IN EFFECT &POLICY# 9TOP
vECALLv Hla.e 5 36
YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ LE STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069492293
16 a
LAST NAME NGUYEN FIRST NAME DANG MIDDLE K
INITIAL
17 STREET❑ NEW ADDREss❑' 20060 104TH PL SE CITY KENT ST WA ZIP 980311563 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO
�
19 DRIVER'S STATE WA SEX M MDD 08 _ 07 2003 39
LICENSE# MMDC7YY
20❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# CDW2406 TArE 41
WA vIN1i 1HGCV3F27NA028079 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2022 MAKE HOND MODEL ACCORD STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DANG NGUYEN 20060104THPL SE KENT WA 98031 D:2069492293 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU&PORGY#ECO STATE FARM 4139561-BO1-47BIN 1 vETILE YES❑ N,J� CITATION# CHARGEUR
LEGALLY
25 =UGENT
(PRINT) OFFICER PHONE BADGE OR ID# 77P�1300
26 11498
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE23155
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13081
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DOBSON DIAMOND R
(/AST FIRST,
ADDRESS&PHONE# D O.B. '
7322 RAINIER AVE S UNIT 207 SEATTLE WA 981183938 2069492293 SEXi F MMDOYyry 03 - 03 - 2003
PASSENGER WITNESS UNIT# 2 P EAT ODS. 3 AIRBAG;2 RESTR. q EJECT ? HELMET INJURY NATURE OF INJURIES
USE 2 CLASS '1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX/ MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.Q.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.
MATTHEW NUGENT 11-14-23 10:22 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 11/25/2023 7:47:42 AM
BADGE OR ID# 11498 ORI# WA0171300 TIME POLICE DISPATCHED 1:12 PM TIME POLICE ARRIVED',4:24 PM
PART I PAGE IT]OF 4�
REPORT NO. EE23155 CASE# 23-13081 OF COLLISION
11/13/23 13:08
OF CbLLI510N
NARRATIVE
23-13081
On 11/13/2023 at approximately 1312 hours, I was dispatched to a non-injury and non-blocking
vehicle collision at the intersection of Renton Avenue South and SW Victoria Street, within the City
Limits of Renton, County of King, State of Washington.
Upon arrival, I confirmed the collision was non-injury. While on scene, I was able to collect each
involved party's information and independent summary of the events leading up to the collision.
The driver of Unit#1 said he and his three passengers (two adults and one juvenile) were traveling
eastbound in about the 13200 block of Renton Ave S and approaching the intersection of SW Victoria
ST in lane 2 of 2. The driver of Unit#1 stated that he needed to get into the right lane (lane 1 of 2) to
make an upcoming right turn at the intersection. The driver of Unit#1 stated he checked the adjacent
lane next to him and believed it was clear of traffic therefore he proceeded to make a lane change
from lane 2 of 2 to lane 1 of 2, and stated that he did see Unit#2 occupying lane 1 of 2, but admitted
to thinking Unit#2 was further back in the lane of travel. The driver of Unit#1 stated that while making
the lane change, Unit#1 struck Unit#2 occupying lane 1 of 2 causing moderate damage to the rear
passenger side door and fender of Unit#1.
The driver of Unit#2 said he and his adult passenger were also traveling eastbound in about the
13200 block of Renton Ave S approaching the intersection of SW Victoria ST but in lane 1 of 2. The
driver of Unit#2 stated he was intending to continue straight when Unit#1 changed lanes from lane 2
of 2 and into lane 1 of 2 which Unit#2 was occupying. Unit#2 was unable to avoid the collision and
subsequently collided with Unit#1. Unit#2 suffered moderate damage to the front driver's side
quarter panel, door, and fender.
The driver of Unit#2 was able to show me footage from his dash-mounted camera. The recording
confirmed Unit#2's statements above.
Based on the above statements, 1 determined that the Driver of Unit#1 (Herrara Galban) was the
predominant factor for the cause of collision as Herrara Galban violated RCW 46.61.140(1) which
states that a vehicle shall be driven as nearly as practicable entirely within a single lane and shall not
be moved from such lane until the driver has first ascertained that such movement can be made with
safety. Herrara Galban entered into Unit#2's lane of travel who had right of way, 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 11/14/2023 10:18 AM Renton, King County,
WA.
PAGE 3 OF 4
REPORT NO. EE23155 CASE# ' 23-13081 DATE AND TIME 11/13/23 13:08
OF COLLISION
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PAGE 4 OF 4