HomeMy WebLinkAbout23-13792 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 23-13792 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 12 - 01 - 2023 1026 17 ❑.❑ S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
HARRINGTON AVE SE BLOCK NO. e✓ 950
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 225 00 FEET e S MILES N B W e NE 9TH ST
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4253759883 0 11
30
6� LAST NAME CHAU FIRSTNAME IRIS MIDDLE S 1 1 2 31
INITIAL
STREET ❑1 950 HARRINGTON AVE NE S207 CITY RENTON ST I WA 2jp, 980563406 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
LRIIVER # STATE WA SEX'F MM D Y' 04 - 18 -
8❑ 2000 1 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES 2❑
3
10 9� P1 AT 14 BXT2527 STATE WA VIN# 3VWD17AJ3FM401270
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# Rom ro
TRLR. YRLR. 3 1 33
12 2 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TR Y GOVT.VEHICLE 5 1 34
13 2015 VOLK JETTA DAMAGE YES NO �MEYER YES❑ No✓
REGISTERED OWNER INFO IRIS CHAU 2022580THELL EVERETT HWY APT BOTHELL WA 980128190 D:4253759883 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14 LIABILITY INSURANCE INSURANCE CO PROGRESSIVE 961112814
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:7148653759
16 a
LAST NAME VEGA FIRST NAME GIOVANNI MIDDLE I N
INITIAL
17❑ STREET ❑', 12668 NE 10TH PL APT D5 CITY' BELLEVUE ST WA ZIP 980052516 37
NEW ADDRESS ❑
18E CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICALt—T�RANSPORTED 38
INTERLOCKYES — NOR INTERLOCK YEs I I NoF YES t l NO❑
19 DRIVER'S STATE WA SEX M D.C... 01 23 _ 1999 39
LICENSE# MMDDYY
HELMET I INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21❑ LICENSE BOF0970 TATe WA VIN1 JF1VA1F63K8827201
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2019 MAKE SUBA MODEL WRX STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO GIOVANNI VEGA 12668 NE 10TH PL APT D5 BELLEVUE WA 980052516 D:7148653759 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO GEIC04591978517IN 9TOP 5
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL
25 io BOTTOM
LY YES s � a
OFFICER'S NAME OQ
(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE26986
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13792
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'
slv/1/sedan rt from pl wgt sedan/2 nb
RTF
Within the city limits of Renton/King/WA I responded to a 2 car blocking crash near the 950 block of
Harrington Ave NE.
I contacted the driver of unit 2 who told me he was northbound on Harrington when unit 1 was making
a left from a parking lot when contact took place. He did not complain of injury and damages did not
require a tow truck.
I contacted the driver of unit 1 who told me the same. She was entering traffic from her residence
and did not see unit 2 and proceeded into his path where contact took place. She did not complain of
injury and damages did require a tow truck.
Information/Insurance only
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 12/1/2023
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 12-01-23 11:23 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 12/5/2023 11:35:35 AM
BADGE OR ID# 2517 OR]# WA0171300 TIME POLICE DISPATCHED; 10:27 AM TIME POLICE ARRIVED 10:37 AM
PART I PAGE IT]OF 3�
REPORT NO. EE26986 CASE# ' 23-13792 DATE AND TIME 12/01/23 10:26
OF COLLISION
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