HomeMy WebLinkAbout24-153 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-1s3 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
2
3❑ DATE OF; M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
COLLISION.. 01 - 1-— 2024 1405 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 2ND ST BLOCK e✓ 800 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e W/L!IAMS AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/NO D:2066798099 0 11
30
6� LAST NAME PHUNG FIRSTNAME NGOC MIDDLE T 1 1 2 31
INITIAL
STREET ❑ 157 HOQWAM PL NE CITY RENTON ST WA ZIP 980594904 2=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10 1❑ P1 ATE 14 BGD7545 STATE WA v N# 58ABK1GG6HU056030
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 1 5 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2017 MAKE LEXS MODEL ES STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 2 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO NGOC PHUNG 117 HOQUTAM PL NE RENTON WA 98059 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILY BX11047133 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2067232077
16 a
LAST NAME GRAY FIRST NAME JOHN MIDDLE N
INITIAL
17❑ STREET ❑', 6504 S NORFOLK ST CITY SEATTLE ST WA ZIP 981185928 37
NEW ADDRESS ❑
18� CDL ., IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YES t l NO❑
19 DRIVERS#
{NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT '1 USE 2 CLASS 1 ❑
21❑ LICENSE I PS23 TATE WA VIN# 1FMDU75W92ZC20436
❑ 41
PLATE#
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2002 MAKE FORD MODEL EXPLORE STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO JOHN GRAYPO BOX961 RENTONWA98057 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 508 2373-1303-47AIN STOP 5
VE""LE ❑ N`L J
,J� CITATION# CHARGE
LEGAL to BOTTOM
0(
LY YES
25 ' e
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE44297
COLLISION REPORT III III III III III 111
1591972 CASE# 24-153
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 January 5, 2024 at 1100 hours this morning, dispatch requested that I respond to a collision at the
intersection of Williams Ave S and S 2nd St, in the city of Renton, county of King, WA. Upon my
arrival I spoke with the driver of unit 2, and he explained that he was going Southbound on Williams
Ave S when the collision occurred. He stated he had a green light and proceeded through the
intersection, but unit 1 ran the red light causing him to strike their front passenger fender. After the
two vehicles collided unit 2's front airbags deployed and disabled the vehicle.
I then spoke with the driver of unit 1 and they explained they were going westbound on S 2nd St,
approaching Williams Ave S. When they went through the intersection it collided with another vehicle.
I asked if they noticed what color the traffic light was when they enter the intersection and the driver
stated they could not recall.
Both drivers were medically checked by Renton Fire and both vehicles we're towed away by bankers
towing.
I provided both drivers with a copy of the exchange of information.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 01-23-24 01:59 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 1/25/2024 2:03:06 PM
BADGE OR ID# 1Y007 OR]#' ' WA0171300 TIME POLICE DISPATCHED; Y:07 Pry TIME POLICE ARRIVED',2:11 PM
PART I PAGE IT]OF 3�
REPORT NO. EE44297 CASE# ' 24-153 DATE AND TIME 01/05/24 14:05
OF COLLISION
Williams
NTS
i
i
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