HomeMy WebLinkAbout24-425 ITFF' "POLCERA II I !�� I III I III I IIII III II I . $ 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-4zs 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 1320 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 3RD ST BLOCK e✓ 500 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a MORR/S AVE S
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2063831211 0 11
30
6� LAST NAME HUANG FIRSTNAME HONGBIAO MIDDLE 1 2 31
INITIAL
STREET ❑ 9215 S 222ND ST CITY KENT ST WA 7jp, 98031 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ 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
LICENSE CJU6780 STATE WA vN# 5TDYRKECXPS175676
10 1❑ PI ATE�
11[-j- TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# ROM ro
TRLR. TRLR 7 3 33
12 2 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T Y GOVT.VEHICLE 1 $ 34
13 1 2023 TOYT SIENNA VN DAMAGE YES NO � �MEYER ves❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 LIABILITY INSURANCE AMERICAN FAMILY 41048.52852.79
IN EFFECT &POLICY# 9TOP
VEHICLe CHARGE 10 BOTTOM 5 36
LEGALLY res No CITATION# 4A0162229 INATTENTIVE DRIVING $
15❑ STANDING 6
MOTOR PEDAL- 'PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE' ❑ ❑ OWNER ❑ YES 1/ NO D:2063724995
16 2
LAST NAME DOAN FIRSTNAME LUCKY MIDDLE
INITIAL
17❑ NEW STREETREs7 11415 SE 214TH ST CITY' KENT ST WA ZIP 98031 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 LDI IVEW # STATE WA SEX M M D.O.B. 10 _ 15 _ 2005 39
20❑ ON DUTY STATUS AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAURS 41
Y 1 NATURE OF INJURIES ❑ 40
❑21❑ ILICENSE PLA E# 622ZGA TATE WA VIN# JTDBU4EE8A9099995 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2010 MAKE TOYT MODEL COROLL STYLE SD VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO DUNG DOAN 11415 SE 214TH ST KENT WA 98031 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE I PORGY#E CO STATE FARM 550 5976-FO8-47IN 1GQI
'E""LE ❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
7NE
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
ON 12327 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE39991
COLLISION REPORT III III III III III 111
1591972 CASE# 24-425
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 01-12-2024 at approximately 1321 hours I observed two vehicles blocking eastbound lane 1 of S
3rd St at Morris AVE S. The vehicles appeared to have been involved in a collision. I observed unit 1
had damage to the front driver side bumper and unit 2 had damage to the front passenger side
bumper and the driver airbag had deployed.
I contacted the driver of unit 1, Huang, who was Chinese speaking only. 1 utilized language line to
communicate with Huang. Huang advised that he was travelling east on S 3rd St when he dropped
something on the passenger side floorboard. Huang reached down to retrieve what he had dropped,
and proceeded through the intersection and struck unit 2.
1 contacted the driver of unit 2, Doan. Doan advised that he was travelling south on Morris AVE S.
Doan observed his light change from green to yellow and he proceeded through the intersection
where he was struck by unit 1.
Both drivers advised they were not injured. The fire department responded to evaluate Huang due to
the airbag deployment, but he was medically cleared.
Both vehicles were inoperable and were towed by Gene Meyer Towing.
I facilitated an exchange of information between the drivers.
Based on the information provided, I am led to believe that unit 1's inattentive driving was the
proximate cause of the collision.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
T.NELSON 01-12-24 03:17 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 111312024 4:00:17 AM
BADGE OR ID# 12327 ORI# WA0171300 TIME POLICE DISPATCHED 1:21 Pry TIME POLICE ARRIVED]4:21 PM
PART I PAGE IT]OF 3�
REPORT NO. EE39991 CASE# ' 24-425 DATE AND TIME 01/12/24 13:20
OF COLLISION
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