HomeMy WebLinkAbout24-913 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
❑ ✓❑ RESULTED ❑ CASE z4-s13 2
INTERSTATE CITY STREET FIRE
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
COLLISION'. 01 - 1-- 2024 1755 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
N 3RD ST BLOCK NO. e✓ 1400 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e MEADOW AVE N
0 1 29
MOTU '�01 VEHtOR Z CLE CYDCLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30
6� LAST NAME GAO FIRSTNAME ZHIYUAN MIDDLE 1 1 2 31
INITIAL
STREET ❑, 164 154TH PL NE CITY BELLEVUE ST WA ZIP 98007 2
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs No✓ INTERLOCKYEs NO✓ YES R No
8❑ LRIIVERS STATE WA SEX'M M L DAY' 10 1— 24 — 1974 2 32
CENSE 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CCX6655 sTArI WAVrN# JT2BG22K8Y0478086
10 F91 PI ATE i4
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# FROM To
TRLR. TRLR 5 1 33
12 2 5 VIN#' VIN#'
ROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 $ 34
13 1 2000 TOYT CAMRY SD DAMAGE YES NO ✓ ves❑ No✓
REGISTERED OWNER INFO —YUAN GAO 164 154TH PL NE BELLEVUE WA 98007 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
1 NSURANCE CO 4
14 LIABILITY INSURANCE BRISTOL WEST G01326237100
LI EFFECT &POLICY# TOPVE—LE CHARGE <1�3
OTTOM 5 36
LEGALLY, Yes❑NO❑ CITATION# 5
15❑ STAIN.D'ING 7 6
UNIT VEHIMOTCLE CYCLE ❑ PEDESTRIAN ❑ OWNER PEDAL YES
❑ DYES✓ NO OLDMET PHONE
16 a
LAST NAME EPSTEIN FIRST NAME AUSTIN MIDDLE JB
INITIAL
17 STREET❑ NEW ADOREss❑' 1818 CHELAN PL NE CITY RENTON ST WA ZIP 98059 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL—T�RANSPORTED � 38
INTERLOCKYES�NO� INTERLOCK YES N0F YEst lNOF,/]
19� DRIVER'S STATE WA SEX M D.O.B. 10 �_ 17 1997 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑LICENSE I 21❑ PLA E# CHS3135 TArE WA VINIi 5YJ3E1EA4PF593962 41
1
42
22❑ PLATILER E# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
rowed By Gov HI 44
VEH YEAR 2023 MAKE TESL MODEL MODE!3
24 STYLE $D DAMAGETOWED TOO✓ BLIN YES
NO✓
❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DA GEbAREA
z Cdd
LIABILITY INSURANCE I PORGY#ECO WASHINGTON INSURANCE 03448435IR71011 1 9TOP 5
IN EFFECT
VEHICLE ❑ I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES NC
25 s e
7m-
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
FERNANDES 12848 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE46762
COLLISION REPORT III III III III III 111
1591972 CASE# 24-913
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 01-25-2024 at approximately 1801 hours I was dispatched the report of a collision at the
intersection of N 3RD ST and Meadow AVE N. The collision was reportedly between vehicle 1, a gold
2000 Toyota Camry, WA/CCX6655, and vehicle 2, a 2023 Tesla Model 3, WA/CHS3135.
A witness, Jeffrey A. Walker, stated that the vehicle 2 was driving east bound on N 3rd St in the
middle lane of three lanes, when vehicle 1 drove northbound from Meadow Ave N on N 3rd St.
Vehicle 1 did not stop at the stop sign and proceeded into the intersection. Jeffrey observed vehicle 2
swerve to the left out of the way, but vehicle 1 still struck vehicle two in the right rear quarter panel.
The driver and registered owner of vehicle 1, Zhiyuan Gao, told me that he drove northbound from
Meadow Ave N onto N 3rd St and struck vehicle 2 after he failed to see him coming.
The driver and registered owner of vehicle 2, Austin B. Epstein, told me that he was driving
eastbound on N 3rd St when vehicle 1 drove into the intersection heading northbound from Meadow
Ave N. He swerved out of the way but was unable to avoid vehicle 1 after he failed to stop at the stop
sign. Austin believed vehicle 1 was driving approximately 15 mph when his vehicle was struck in the
right rear quarter panel.
I observed damage to both vehicles consistent with all versions of the incident. The Tesla had
damage to the right rear quarterpanel and the Camry had damage to the front bumper. I took
photographs of the damage and assisted with an exchange of information. There were no injuries.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
MAR/A FERNANDES 01-25-24 11:48 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 2/2/2024 2:26:21 PM
BADGE OR ID# ! 1Y848 ORI#' WA0171300 TIME POLICE DISPATCHED; 5:55 PM TIME POLICE ARRIVED',5:55 PM
PART I PAGE IT]OF 3�
REPORT NO. EE46762 CASE# 24-913 DATE AND TIME 01/25/2417:55
OF COLLISION
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