HomeMy WebLinkAbout23-13983 ITFF' "POLCERA II I !�� I III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
CASE 23-13983 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIl.I F ❑ LOCAL AOENC 4Y00 3
HIT&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 2355 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
OAKESDALEAVESW MILEPOST ST e✓ 0 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ W e SW41ST STREET
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2066058463 0 11
30
6� LAST NAME TRUONG FIRSTNAME DAN MIDDLE Q 1 1 2 31
INITIAL
STREET ❑ 11802 14TH AVE S CITY BURIEN ST WA 2jp, 98168 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVERS STATE WA SEX'M MM DAY' 06 1- 04 - 1963 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ PI ATE BPK1782 sTArI WAurN#' 4T1SK12EXSU538357
[ � TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T v GOVT.VEHICLE 1 $ 34
13 3 199$ TOYT CAMRY SD DAMAGE vE5 0NO agW�MEYER ves❑ No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑
14 LIABILITY INSURANCE INSURANCE CO ALLSTATE 987.854.355 35
IN EFFECT &POLICY# �1'OP
ve'C ❑ 36
LEGALLv res❑NO❑ CITATION# CHARGE BOTTOM
15❑ NDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:5064595097
16 2
LAST NAME WAGAN FIRST NAME JOVENNE MIDDLE IT
INITIAL
17 STREET I❑ s❑' 35310 25TH AVE SW APT D CITY' FEDERAL WAY ST WA ZIP 98023 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑NO� INTERLOCK vEs I I NOF YEs t l NOF,/
19 D IVEW #
❑ ON DUTY STATUS AIRBAG,6 RESTR 4 EJECT 1 H EET 2 NJAUR CLSSY 6 BACK,RIGHT WRIST,AND NECK PAIN ❑OF INJURIES 40
❑21❑ PLATE# CBY4654 TArE WA VIN# 41
SFNYF8H53M6034585 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. N#. 43
RLR
'I
TOWED BV Gov HI 44
VEH YEAR 2021 MAKE yOND MODEL pgSSPOR STYLE (/T —VEHICLE
TOWED✓ NOO BLIN GENE MEYER YES No�/
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE DAGED AREA
4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 506-6333-AO5-47
IN CTOP
—e E ❑ ,J� CITATION# CHARGE I BOTTOM
LEGALLY YES N 6
25 7MICAELA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 CASTAIN 7 12573 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE36264
COLLISION REPORT III III III III III 111
1591972 CASE# 23-13983
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) OAMIL RUBYD
(LAST FIRST,
ADDRESS&PHONE# D O.B.
13106 SE 228TH PL KENT WA 98031 2538765918 SEXi F MMDDYyry 06 - 22 - 1970
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS❑i UNIT# 2 POS S AIRBAG 6 RESTR. 4 1 EJECT I I USE 1 2 CLASS 6 BACK,R/B,STOMACH PAIN
NAME
`(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX t 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'
Unit 1: Blue 1995 Toyota Camry (WA/BPK1782); Dan Truong (DOB 06/04/1963)
Unit 2: 2021 Honda Passport (WA/CBY4654); Jovenne Wagan (DOB 07/24/1994)
On 12-06-2023 at approximately 2356 hours I was dispatched to a blocking collision that occurred at
the intersection of Oakesdale Ave SW and SW 41 st Street, in the City of Renton, King County, WA.
Upon arrival, I contacted both parties, who agreed upon how the collision occurred. Renton Fire
arrived on scene and cleared the occupants of Unit 2. Unit 1 did not request to be evaluated.
Unit 1 was traveling westbound on SW 41 st Street and stopped at the stop sign as he approached the
intersection above. Unit 2 was traveling southbound on Oakesdale Ave SW. As Unit 2 was
approaching SW 41st Street southbound on Oakesdale Ave SW, Unit 1 failed to clear the intersection
before continuing westbound through the intersection and collided into Unit 2. Unit 1 was attempting
to pull into a parking lot on the west side of Oakesdale Ave SW.
There is damage to the passenger side of Unit 1. There is damage to the front end of Unit 2. Both
vehicles were not drivable and were towed to the Gene Meyer Towing Lot.
Based off the statements made by both parties, there is proximate cause for Unit 1 in this collision.
I certify (or declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MICAELA CASTAIN 12-06-23 01:46 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.THIELMAN 11462 1 11112024 7:57.19 PM
BADGE OR ID# 12573 OR]#' WA0171300 TIME POLICE DISPATCHED 11:56 PM TIME POLICE ARRIVED 11:57 PM
PART I PAGE IT]OF
REPORT NCV EE36264 CASE# 2303983 DATE AND TIME 12/05/23 23:55
OF COLLISION
ton
AN
SW 4 1 St Street
b
l
3
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