HomeMy WebLinkAbout24-4071 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c
COLLISION REP FIT 1591971
SASE 24-4071 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 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 N E IN CITY# ❑
COLLISION'. 04 - 1-- 2024 2251 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N SOUTHPORT DR
BLOCK NO. e✓ --- ----�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 50 00 FEET MILES e S ❑ W e I405 OFF RAMP
0 2 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES NO D:3607286367 0 9 30
6❑ LAST NAME FREEZE FIRSTNAME COLIN MIDDLE K 1 1 2 31
INITIAL
STREET 01 9316 46TH AVE S CITY SEATTLE ST WA 2jp, 98118 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO�/ YES R No�/
8 LDRIVER # STATE WA SEX'M MI B 04 1— 30 — 2004 2 32
9 ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 H USE 2 1 CLASS NATURE OF INJURIES 2❑
3
10[3 P1 ATE 14 AUZ0470 STATE WA V N# 3FADP46JOEM241206
11[-jTRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# IR.. ro
TRLR. TRLR 1 7 33
12 0 0 VIN#' VIN#
:: FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 1 9 34
13 1 2014 FORD FIESTA SD DAMAGE YES NO �LII� RS YES❑ No
REGISTEREDOWNERINFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE U INSURANCE CO USAA 019105509C 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv res❑NO❑ CITATION# 1 o BOTTOM
15❑ �STA""
G 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2064887079
a
LAST NAME NGUYEN FIRST NAME PHUONG MIDDLE T
INITIAL
17 STREET NEW ADDREss❑' 3513 LINCOLN AVE NE CITY RENTON ST WA ZIP 98056 37
18� CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL t—TRANSPORTED 38
INTERLOCK YEs❑NO� INTERLOCK yEEsl I I NOF YES t l NO�
19 LICENSE# STATE WA ]SEX IF M D.C.B. 03 _ 05 _ 1984 39
20❑ ON DUTY STATUS I
AIRBAG 1 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# D12594D TATE 41
WA VIN1 3GTU9AEF7LG352860 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2020 MAKE GMC MODEL SIERRA STYLE PK DAMAGE TOWED NOO✓ BLIN TOWED By ov HyES NO 1/ 44
24❑ ES
REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU PORGY#E CO FARMERS 532927969IN 1 9TOP
VE."Le ES N CITATION# CHARGE
� i o BOTTOM
LEGALLY y
25❑ J s
7BRYAN
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY26NAME
12489 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE68255
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4071
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) NGUYEN HOANG H
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
3513 LINCOLN AVE NE RENTON WA 98056 4253897719 SEX M MMDovyry 10 - 10 - 1981
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 POS. 3 2 4 1 USE 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) NGUYEN ELENA
ADDRESS&PHONE# D O B
3513 LINCOLN AVE NE RENTON WA 98056 SEX IF MMopvuvv 02 _ 13 _ 2019
SEAT HELMET NJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 2 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&PHONE#
SEX D.O.B.MMDD -❑
YYYY.
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
❑ ❑ POS. USE CLASS ----�
NARRATIVE'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
BRYAN GROZAV 04-13-24 11:45 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 4/15/2024 11:45:37 AM
BADGE OR ID# 12489 ORI# WA0171300 TIME POLICE DISPATCHED; 10:53 PM TIME POLICE ARRIVED',10:55 PM
PART Ei PAGE IT]OF 4]
REPORT NO. EE68255 CASE# 24-4071 OF COLLISION
04/13/24 22:51
OF CbLLI510N
NARRATIVE
CASE 24-4071
This incident was captured on my body worn video camera and/or in-car dash camera. This report is
a summary of events that occurred and is not an exact sequencing of events.
On Saturday April 13th, 2024, at approximately 22:53, 1 responded to a 911 call regarding a two-
vehicle collision at the 1405 off-ramp to North Southport Dr within the City of Renton, King County,
Washington.
'CALL REMARKS: WO LOC...2 MVA...NI...NB...VEH DAMAGE ESTIMATED OVER $1,000...REQ
PD RESPONSE.
UNIT ONE: RED 2014 FORD FIESTA WASHINGTON LICENSE: AUZ0470
UNIT ONE DRIVER: COLIN K. FREEZE (DOB: 4.30.2004)
UNIT TWO: WHITE 2020 GMC SIERRA WASHINGTON LICENSE: D12594D
UNIT TWO DRIVER: PHUONG T. NGUYEN (DOB:3.05.1984)
I arrived on scene and contacted the involved parties who indicated they were not injured and all
declined aid. Phuong said she was exiting the 1405 ramp merging onto North Southport Dr and was
stopped at the yield sign looking for traffic when she was hit by unit one. Unit two had minor to the
rear bumper and was deemed drivable.
Colin reported he was getting ready to merge onto North Southport Dr from the 1405 off ramp, when
completing the turn unit two was stopped in the lane of traffic and wasn't able to stop in time before
hitting unit two. Unit one had front end damage and was inoperable. Banker's towing arrived and
towed the vehicle.
I provided the involved drivers a business card with the case number.
This concludes my involvement in this case.
I certify/declare under penalty of perjury under the laws of the State of Washington that the foregoing
is true and correct.
Electronically signed by B. Grozav #12489 on 4.13.2023 at 23:44 hours in Renton, WA.
PAGE 3 OF 4
REPORT NO. EE68255 CASE# 24-4071 DATE AND TIME 04/13/24 22:51
OF COLLISION
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PAGE 4 OF 4