HomeMy WebLinkAbout24-2338 POLICETRAFF'c" III !�� I IIIllI111IN II II I REPORT NO. EE55892 170
27
COLLISION REP FIT 1591971
CASE 24-2338 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 3
HIT 8 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# ❑
COLLISION.. 03 - 1-- 2024 1638 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
EASTVALLEYRD ST e✓
MILEPOST 3300
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 300 00 FEET MILES e S B W e S 34TH ST
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2536569539 0 11
30
6� LAST NAME SICCUA FIRSTNAME DANIEL MIDDLE A 1 1 2 31
INITIAL
STREET ❑, 1324 122ND AVE E CITY EDGEWOOD ST WA ZIP 98372 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8 LRIIVERCENS # STATE WASEX'M MDMDo 04 1988 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU SE CUSS 1 NATURE OF INJURIES z❑
3
10 9❑ P1 ATNES# BKS0784 sTAr WAuN# 1HGFA16567L137714
0 TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. YRLR. 3 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 8 2007 HOND CIVIC SD DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
3 4
14 $ LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
VE— CHARGE 10 BOTTOM 5 36
LEGALLY YEs NO CITATION# 4AO131301,4AO131301 FAIL YIELD PRIVATE RD MOTOR
15❑ STANDING 7 6
MOTOR PEDAL-: 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES 1/ NO D:4259740180
16 a
LAST NAME CHU FIRST NAME DEREK MIDDLE I T
INITIAL
17❑ STREET ❑', 14720 SE 145TH PL CITY RENTON ST WA ZIP 98059 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDIIVEW # STATE WA SEX M M .C.B. 11 26 _ 1997 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE 984TOO TATE WA 5TDZA23C75S371554 ❑ 41
PLATE# VIN#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2005 MAKE TOYT MODEL SIENNA STYLE VN VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO NAI-CHI YU 12840 SE 4TH CT E6 BELLEVUE WA 98006 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY INSURANCE I PORGY#ECO LIBERTY MUTUAL AOS-261-798495-70 3 1 1GQ
5
IN EFFECT
VE""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25 s 7 6
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE55892
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2338
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'
Unit 2 (Chu) northbound on East Valley Rd. Unit 1 (Sic Cua) exiting storage company at 3330 East
Valley Rd, west out of driveway turning onto southbound East Valley Rd. Unit 1 failed to yield to unit
2; unit 1 nose contacted front right panel of unit 2, and scraped all the way down the right side of unit
2. Driver 1 Sic Cua said that he looked both ways, but did not see the oncoming unit 2. Sic Cua also
stated that he did not have an insurance policy covering unit 1.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 03-02-24 06:29 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 31412024 8:35:59 AM
BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED 4:50 PM TIME POLICE ARRIVED 4:54 PM
PART I PAGE IT]OF 3�
REPORT NO. EE55892 CASE# ' 24-2338 DATE AND TIME 03/02/24 16:38
OF COLLISION
Unit I
3330 East
U n it
Valley Rd
4
v
x`
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