HomeMy WebLinkAbout24-2926 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-2926 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4900 3
HIT&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 CITY#
cowsloN 03 - 18 - 2024 0649 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
108TH AVE SE BLOCK NO. e✓ 18200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 .❑ FEET e S ❑ W e SE 182ND ST
❑ �
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4255634707 0 11
30
6� LAST NAME TAN FIRSTNAME ZHI MIDDLE X 1 1 2 31
INITIAL
STREET ❑ 18322 112TH AVE SE CITY RENTON ST WA ZIP 980557136 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
�Z I INTERLOCK YES[:]No NTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10 9❑ Pi aT�S� AWB0749 sTArI WAurN# 4T38K3B68FU118000
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM TO
TRLR. TRLR. 3 1 33
12 4 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 2015 TOYT VENZA 4D DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO yUTAN M322112THAVE SE RENTON WA 98055 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO STATE FARM 4605103EO4.47B 3 4
IN EFFECT &POLICY# 9TOP
VENICLE 5 36
LEGALLY
YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT U2 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2068164313
16 2
LAST NAME NATAE FIRST NAME MESERET MIDDLE A
INITIAL
17 STREET I55TH LN SE CITY' KENT ST WA ZIP 980425566 4❑ 37
NEW ADOREs�' 27809 1
18� CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL TRANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs I I NOF YEs t l NO❑
19 D IVEW #
❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 H EET 2 NJAU SY 7 COMPLAINED OF HEAD AND NECK ❑F—NATURE OF INJURIES 40
❑ 41
21❑ ILICENSE PLATE# AG12215 TArE WA VIN1i JN8AZ1MWSBW181065 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2011 MAKE NISB MODEL MURANO STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO HABETIEABETEW27809155TH LN SE KENT WA 98042 VEHICLE NO.2
SHADE DAGELLAREA
LIABILITY
INSURANCE INSU&PORGY#E CO FARMERS 535040499IN 1GQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
C.JACOBS 1953 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE67085
COLLISION REPORT III III III III III 111
1591972 CASE# 24-2926
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 3-18-24 at about 0700 1 arrived at the intersection of 108th Ave SE and SE 181st ST for a 2
vehicle collision. I contacted both vehicles in or near their vehicles. Both drivers identified themselves
via WADL. Driver 1, Zhi Tan told me;
She had turned right from SE 182nd St to northbound 108th when unit 2 came from the rear and
around her before colliding with the front of her vehicle.
She was positive that she was already upon 108th AVE se. prior to the collision.
Driver 2 told me;
She was driving northbound in lane 1 when unit 1 suddenly turned out in front of her.
Initially she said she was not injured. After we concluded our contact, she needed to go to the doctors
office for pain and not feeling well.
After observing the damage to both vehicles it was obvious that unit 1 had not completed its turn and
was not legally upon 108th Ave SE prior to the collision. Driver 1 was adamant that she was, but the
damage to both vehicles was not consistent with what she was telling me.
I verbally warned driver 1 and released her. Both vehicles were released to the drivers.
This incident occurred in the city of Renton, County of King.
I declare under penalty of perjury under Washington state law that the foregoing is true and correct.
C. Jacobs/1953
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS O4-01-24 01:27 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 411012024 3:55:02 PM
BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED! 6:54 AM TIME POLICE ARRIVED';7:00 AM
PART I PAGE IT]OF 3�
REPORT NO. EE67085 CASE# 24-2926 DATE AND TIME 03/18/24 06:49
OF COLLISION
i
PAGE 3 OF 3