HomeMy WebLinkAbout24-464 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
❑ ❑ RESULTED ❑ CASE z4-4s4 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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#
cawsloN 01 - 1-- 2024 1903 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
NE 4TH ST BLOCK NO. e✓ 6400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e 156THAVE SE
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2064719738 0 81
30
6� LAST NAME SHARP FIRSTNAME MICHAEL MIDDLE A 9 2 31
INITIAL
STREET ❑ 18201 RENTON MAPLE VALLEY RD SE CITY MAPLE VALLEY ST WA ZIP 98038 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ I INTERLOCK YES NO�/ YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ Pi aT�S� C33919G sTArI WAvIN# 5TEMU52N18Z555272
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR. TRLR 3 7 33
12 0 VIN#' VIN#'
ROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE J 9 34
13 4 2008 TOYT TACOM PK DAMAGE YES NO YES[:] No
No
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 3 4
14 INSURANCE GEICO 4547721144
IN EFFECT EFFEE CT &POLICY# 9TOP
VEHlcl.e CHARGE 1060TTOM 5 36
LEGALLY YES❑NO❑ CITATION# 5
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064745927
16 a
LAST NAME CHEN FIRST NAME LIQIANG MIDDLE
INITIAL
17 STREET❑ NEW ADDREss❑' 6516 NE 1ST ST CITY RENTON ST WA ZIP 98059 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INERLOCKYEs❑NoF INTERLOCK ves NoF YEs NO /
19 DRIVER'S STATE WA SEX M I D.O.B. 08 _ 23 _ 1963 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
LICENSE I ❑21❑ PLA E# BKS8869 TArE 41
WA vIN# WDDHF8J88F8085169 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
rowed ev Gov H 44
VEH
24❑ YEAR 2015 MAKE MERZ MODEL E350 STYLE $D DAMAGETOWED TOO✓ BLIN YE S N.7
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSURANCE
#E CO NATIONWIDE 7246JO21336IN 1 GD
LEGAL25
LY YES Nu
❑ s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.ARNOLD 12509 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE48837
COLLISION REPORT III III III III III 111
1591972 CASE# 1 24-464
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 01/13/2024 at 1905 hours I was dispatched to a 2 vehicle non-injury collision at the intersection of
NE 4th St and 156th Ave SE. When I arrived on scene I observed the driver of Vehicle 1 and some
bystanders pushing Vehicle 1 out of the roadway, while Vehicle 2 remained in the spot that the
collision occurred. I spoke to the driver of Vehicle 2 who stated that he was stopped facing West in
the number 3 lane, which is a left turn only lane, preparing to make a lefthand turn. The driver of
Vehicle 2 stated that as he was stopped, Vehicle 1 was traveling West on NE 4th St in the number 2
lane and maneuvered left to enter the number 3 lane. Vehicle 2's driver stated that the front driver
side bumper of Vehicle 1 collided with the rear passenger side bumper of Vehicle 2. The driver of
Vehicle 1 stated that he was traveling West on NE 4th St approaching the intersection of NE 4th St
and 156th Ave SE in the number 2 lane when he maneuvered Vehicle 1 left to enter the number 3
lane. Vehicle 1's driver said that it appeared that Vehicle 2 began to leave the number 3 lane, when
Vehicle 1's front driver side bumper made contact with Vehicle 2's rear passenger side bumper.
Vehicle 1's airbags were deployed and I had Renton Fire Authority (RFA) respond to assess Driver 1.
Driver 1 told me that he was later unsure as to what happened as it all happened too fast. Vehicle 1
was rendered inoperable and would not start so a tow was called at the owners request to have it
removed. It appears that Driver 1 may have attempted to avoid a collision by maneuvering to the right
but was unable to stop or maneuver his vehicle fast enough, leading to the damage being located on
the front drivers side bumper of Vehicle 1 and the rear passenger side bumper of Vehicle 2.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.ARNOLD 01-13-24 07:55 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.MOYNIHAN 11288 1 2/9/2024 9:01:03 PM
BADGE OR ID# 112509 ORI#' WA0171300 TIME POLICE DISPATCHED; 7:05 Pry TIME POLICE ARRIVED 7:09 Pry
PART I PAGE IT]OF 3�
REPORT NO. EE48837 CASE# ' 24-464 DATE AND TIME 01/13/24 19:03
OF COLLISION
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