HomeMy WebLinkAbout23-5619 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ FIRE ❑ CASE# , 23-5619 2 6 0
INTERSTATE CITY STREET RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F E: LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 2$
i TRIBAL 1 02 STRUCK BUILDING
RESERVATION
2
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# ❑
GawsloN 05 - 18 - 2023 1527 17 ❑.❑ N E IN S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
SE 180TH ST BLOCK NO. e✓ 11101
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 30 00 FMILES N EET e S B E e 111THAVESE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES ,/NO D:2067660814 30
6� LAST NAME LE FIRSTNAME LIED MIDDLE V 1 1 2 31
INITIAL
STREET ❑ 17922 112TH AVE SE CITY RENTON ST WA ZIP 980556523 2
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10� P1 aT�S� BWV2392 sTATI WAvIN# JF2SKAJC1MH453747
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM TO
TRLR. A'RLR. 1 5 33
12❑ VIN#' VIN#
RomM TO
34
13❑ VEH.YEAR202,1 MAKE SUBA MODEL FOREST STYLE P4 VEHICLETOWED0NOOffBLIN TSIgWgYMEYER vOs❑ENo /
DAMAGE IILLJJII (5�IV6
REGISTERED OWNER INFO LIEU LE 11122112TH AVE SE RENTON WA 98055 D:2067660814 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILI INSURANCE INSURANCE CO AMERICAN FAMILY INSURANCE A103447571 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 3A0382301 FAIL STOP AT STOP 1 o eorroM
15❑ STANDING 7 6
MOTOR P PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ElEDAL- ❑ ❑CYCLE OWNER ❑ YES 1/ NO D.2o 63354150
16❑
LAST NAME ROBBINS FIRST NAME CYNTHIA MIDDLE R
INITIAL
17 STREET I❑ s❑' 11101 SE 180TH ST CITY' RENTON ST WA ZIP 98055 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK vEs I I NOF YEs t l NO❑
19 DRIVE #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ TRLR R 43
LR
VIN#. N I #.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ I—I CITATION# CHARGE
LLY i o BOTTOM
LEGA YES N
,.
25 s e
7m-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
FERNANDES 12848 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF09254
COLLISION REPORT III III III III III 111
1591972 CASE# 23-5619
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LE T MASON
(LAST FIRST,
ADDRESS&PHONE# D O.B.
17922 112TH AVE SE RENTON WA 980556523 SEX M MMDOYyry 06 - 28 - 2014
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 1 POS. 9 2 10 1 USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# DOB
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIRST 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.
MARIA FERNANDES 05-18-23 06:05 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1 8/28/2024 12:36:02 AM
BADGE OR ID# ( 12848 OR]# WA0171300 TIME POLICE DISPATCHED 3:28 PM TIME POLICE ARRIVED',3:37 PM
PART I PAGE IT]OF 4�
REPORT NO. EF09254 CASE# 23-5619 OF COLLISION
05/18/23 15:27
OF CbLLI510N
NARRATIVE
On 05-18-2023 at approximately 1528 hours I was dispatched to the report of a single vehicle
collision into a house at 11101 SE 180TH ST Renton, King, WA. It was reported that a vehicle, later
identified as a gray 2021 Subaru Forester, WA/BWV2392, ran into a house, trapping a resident inside
of their bedroom. It was later reported that there were no injuries.
I arrived and contacted the driver and registered owner of the Subaru, Lieu V. Le (DOB: 12-23-1951).
Lieu told me that he was driving southbound on 111 th Ave SE towards SE 180th ST with his
grandson, Mason T. Le (DOB: 06-28-2014), who was in the right rear passenger seat. Lieu said he
saw a dog in the road and attempted to avoid hitting it. Lieu said he tried to brake but pressed the gas
pedal instead. Lieu passed through the intersection of SE 180th ST and 111th Ave SE without
stopping at the stop sign and drove into the northside of the house. The Subaru caused damage to
the north walls of two separate bedrooms, and front-end damage to the vehicle. Lieu and his
grandson were not injured.
I contacted the owner of the house, Cynthia R. Robbins (DOB: 01-29-1948), and she confirmed that
no one inside of the house was injured. A resident inside the house, Wayne E. Nesting (DOB: 07-12-
1977), showed me surveillance footage of the incident. I observed the Subaru drive southbound on
111th Ave SE, fail to stop at the stop sign, drive through the intersection, and into the house. The
Subaru did not appear to swerve, slow down, or brake. Lieu admitted that he did not stop at the stop
sign and drove into the house without braking.
I issued Lieu a traffic citation #3A0382301 for RCW 46.61.190.2 Failure to Stop At a Stop
Sign/Intersection which will be mailed to him.
I provided the case number to both involved parties.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Ofc. M. Fernandes 05-18-2023 Renton, WA
PAGE 3 OF 4
REPORT NO. EF09254 CASE# ' 23-5619 DATE AND TIME 05/18/23 15:27
OF COLLISION
NOT TO SCALE
11101 SE 190TH ST
111TH AVE SE
SE 1 BOTH ST
PAGE 4 OF 4