HomeMy WebLinkAbout23-13972 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 23-13972 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ RESERVATION STRUCK
z
3❑ DATE of M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cowsloN 12 - 1-- 2023 1633 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
LAKE WASHINGTON BLVD BLOCK NO. e✓ 1300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e HOUSER WAYN
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO �/ D:3057781986 0 4 30
6F1 LAST NAME MUI FIRSTNAME KINTING MIDDLE K 1 1 2 31
INITIAL
STREET ❑1 3340 CUMBERLAND BLVD SE#725 CITY ATLANTA ST GA 2jp, 30339 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCK YES NO Z YE. No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES z❑
3
10 6❑ P1 ATE 14 BJN7717 STATE TN v N#' 3N1CN8EV8PL831019
11[-jTRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
:: FROM TO
VEH.YEAR 2023 MAKE MODEL STYLE VEHICLE TOWED TO BLIN 5 7 TOWED BY GOVT.VEHICLE 34
13 4 NISS SENTRA SD DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO IAN HOLDINGS 300 CENTRE POINTE DR VIRGINIA VA VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 IN EFFECT
INSURANCE PV HOLDINGS CORPORATION ACCOUNT ID#01858623616
IN EFFECT &POLICY# 9TOP
VEHlcl.e CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs NO 1/ D:2064555427
16 a
LAST NAME LEATHLEY FIRST NAME JAMES MIDDLE A
INITIAL
17❑ STREET NEW ADOREs7 26919 216TH AVE SE CITY MAPLE VALLEY ST WA ZIP 98038 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19[-] D IVEW #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ 41
21❑ PLATE# CKE3009 TATE WA VIN# STDKDRBH8PS517817 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. N#.
43
RLR
'I
VEH YEAR 2023 MAKE TOYT MODEL HIGHLAN STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JAMES LEATHLEY 26919216TH AVE SE MAPLE VALLEY WA 98038 D:2064555427 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO ALLSTATE 987313888IN IULlliKOTlTlfll;0-
"'-Fl"VE""LE ❑ ,J� CITATION# CHARGELEGALYYES N`L J25 7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE29361
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13972
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'
On December 6/20/23 at 1633 hours dispatch requested that I respond to a collision that occurred at
1300 Lake Washington Blvd north, in the City of Renton, County of King, and State of Washington.
The reporting party stated that both vehicles pulled into a nearby parking lot at the Hampton Inn and
Suites.
Upon my arrival I spoke with the driver of unit 1, a Nissan Sentra. The driver identified as Kinting Mui,
stated she was driving southbound on Lake Washington Blvd north when the collision occurred. She
proceeded to explain that she was stopped on the railroad tracks when the railroad signs came down.
Tina said she panicked and proceeded to move forward but the brakes were possibly locked. She felt
like the breaks were stiff. The vehicle was not moving so she shut down the vehicle and restarted it.
The vehicle jerked forward and proceeded to strike unit 2 which was making a left turn into Gene
Coulon.
I did spoke with the driver of unit 2, a Toyota Highlander. The driver identified as James Leathley,
explain he was making a left turn from Lake Washington Blvd north to Gene Coulon. As he
proceeded through the green light, unit 1 ran into his front bumper.
I provided both drivers with an exchange of information form and I also provided that with my contact
info and case number.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 12-06-23 01:20 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
DESIRES SCOTT 10272 1211112023 6:30:06 PM
BADGE OR ID# 12007 OR]# WA0171300 TIME POLICE DISPATCHED 4:48 Pry TIME POLICE ARRIVED',5:10 PM
PART I PAGE IT]OF
REPORT NO. EE29361 CASE# ' 23-13972 DATE AND TIME 12/05/23 16:33
OF COLLISION
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