HomeMy WebLinkAbout24-4376 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-4376 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 28
0 5
RESERVATION
TRIBAL UNITS 02 STRUCK
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
C{YLLISION'.. O4 - 1-- 2024 1016 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
EDMONDS AVE NE BLOCK NO. e✓ 1200 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV e NE 12TH ST
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:2068511424 0 4 30
6� LAST NAME LEVERON FIRSTNAME ISABEL MIDDLE B 1 1 2 31
INITIAL
STREET ❑1 7706 15TH AVE SW CITY SEATTLE ST WA ZIP 98106 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YEs NO
LRIIVER # STATE WA SEX'F MM D Y' 11
8❑ — 14 — 1966 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10 2❑ I P1 ATNES# ARG7137 sTAr WAuN# 4T18F1FK7EU394260
TRAILER STATE TRAILED STATE
11 2 5 PLATE# PLATE# ROM To
TRLR. TRLR $ 1 33
vIN#'
12 0 0 VIN#
>;. FROM TO
VEH.YEAR 2014 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 4 TOYT CAMRY SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO TRAVELERS 6134539382031 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 1 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4258663467
16 a
LAST NAME NGUYEN FIRST NAME THI MIDDLE B
INITIAL
17❑ STREET ❑', 401 GRANDEY WAY NE CITY RENTON ST WA ZIP 98056 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES
t t— l NO❑
19 LICENSE# STATE WA SEX F M.C... 11 � 05 _ 1990 El 39
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CKG2627 TAre WA vIN# 2T2KGCEZORC041739
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
GI
VEH YEAR 2024 MAKE LEX$ MODEL NX 300H STYLE UT DAMAGE TOWED TOO✓EHICLEBLIN TOWED BY OV HyES NO 44
24❑ fj
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLE N0.2
SHADEDAMAGED AREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 5474052-DO3-47IN 1ULlliKOTlTlfll;0-
(PRINT)'E""LE ❑ ,J� CITATION# CHARGEYES N`L J25 =KI
OFFICER PHONE BADGE OR ID# AGENCY
J
26
12598 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE71743
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4376
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 Monday, April 22, 2024 at 1018 hours, I was dispatched to a two-vehicle collision in the area of
Edmonds Ave NE and NE 12th St.
The following occurred within the City of Renton, King County; Unit 1 - WA/ARG7137 was being
driven by Isabel Leveron and was driving northbound on Edmonds Ave NE in the 1200 block. Unit 2 -
WA/ CKG2627 was driven by Thi Nguyen and was turning northbound from NE 12th St. Isabel stated
she was on Edmonds Ave NE and went through the intersection and collided with Unit 2 while they
were turning. Isabel stated she was unable to avoid colliding with Unit 2. The front bumper of Unit 1
crashed into the front bumper and quarter panel of Unit 2. The driver of Unit 2 indicated she was
turning left after she stopped and was struck.
Based on the statements I was unable to determine which driver was at fault.
Both vehicles sustained damage and neither vehicle needed to be towed.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
J.WISN/EWSKI 04-22-24 11:43 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
S.WOODWARD 11528 4/26/2024 1:17:27 PM
BADGE OR ID# 12598 OR]# WA0171300 TIME POLICE DISPATCHED; 10:18 AM TIME POLICE ARRIVED;10:20 AM
PART I PAGE IT]OF
REPORT NO. EE71743 CASE# ' 24-4376 DATE AND TIME 04/22/24 10:16
OF COLLISION
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