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HomeMy WebLinkAbout24-02165 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c COLLISION REP FIT 1591971 CASE 24-02165 z INTERSTATE ❑ CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4300 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' 02 - 1-- 2024 2223 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ BLOCK HILLCREST LN NE M1400 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 6❑ 100 00 FEET e S ❑ W e K/RKLAND AV NE 1 5 29 MOTOR PEDAL- DAM THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El YEs No ,/ D:4696737389 1 4 30 6� LAST NAME BROWN FIRSTNAME PARIS MIDDLE V 1 1 2 31 INITIAL STREET 01 4600 DAVIS AV S F204 CITY RENTON ST WA 21p 98055 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 ,/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/ 8❑ LDRIVER # STATE WA SEX'M MID LOB 08 - 09 - 1984 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� RS13957 sTArI WAurN# 1FDFE4FS4KDC32121 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR. 0 33 12 0 0 VIN#j VIN#' 2019 FORD ECONO SNYES[:] ❑ FROM 34 ❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 13 4 DAMAGE YES NO �/ YES NO REGISTERED OWNER INFO ACCESSIBLE SVC KING COUNTY 720 SENECA ST STE 107#509 SEATTLEWA98101 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILITY INSURANCE INSURANCE CO KC METRO SELF INSURED SELF INSURED 3 4 IN EFFECT &POLICY# 9TOP ve'CLE CHARGE 5 36 LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM 15❑ STAMOTIND'ING 8 UNIT VE IOOR Z CYCLE ❑ PEDESTRIAN ❑ OWN APROPERTY ❑ DYES NO SOLD MET PHONE 16❑ LAST NAME UNKNOWN FIRST NAME MIDDLE INITIAL STREET 17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED � 38 INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES t l NOF,/ 19 LLIICENS RIVEWS# STATE SEX U MMDDYY 39 WELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''1 USE 9 CLASS 0 ❑ 21❑ LICENSE B27738V TAre WA VIN# 5TEHN72N32Z039738 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE# STATE 23❑ 43 TRLR RLR UIN#. 'IN#. VEH YEAR 2002 MAKE TOYT MODEL TACOMA STYLE TR VEHICLETOWED TO BLIN TOWEDBY GOV HI 44 L4❑ DAMAGE YES NO,/ YES NO REGISTERED OWNER INFO SOUA HANG 1457 HILLCREST LN NE RENTON WA 98056 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 INAEFFIECTTY NSURANCE❑ &POINSULICY#E CO NONE 1 9TOP 5 "'LE ❑ ,.I— CITATION# CHARGE i o BOTTOM LEGALLY YES N`LJ 25 $ ' =HSU AME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 12651 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EE55220 COLLISION REPORT III III III III III 111 1591972 CASE# 24-02165 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME(IAST FIRST,MIDDLE INITIAL) HANG PO C ADDRESS&PHONE# D O.B. ' 22766 SE 242ND ST MAPLE VALLEY WA 980386870 4253513335 SEX M MMDDYyry 05 - 08 - 1974 PASSENGER WITNESS U SEAT ' AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ✓ NIT# POS. USE CLASS NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX' MMDDYVYV PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY 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' Unit 1 King County Ride Share bus backs into parked Unit 2 along 1400 block of Hillcrest Ln NE causing non reportable non disabling damage to the rear driver side bumper of Unit 2 and no observable damage to the rear bumper of Unit 1. Witness reported observing collision while present nearby. Witness is also family member of owner of Unit 2. Witness reports that Unit 1 caused metal crease damage into the rear driver panel above the bumper to Unit 1. Unit 2 driver reports that his low speed backing collision would not have cause said damage since the angle and level of the bumpers between the two vehicles would not have caused said impact to the body work to Unit 1. No injuries. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 02-27-24 11:36 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 31112024 2:43:35 PM BADGE OR ID# ! 12651 OR]# WA0171300 TIME POLICE DISPATCHED; 10:25 PM TIME POLICE ARRIVED 10:32 PM PART I PAGE IT]OF 3� REPORT NO. EE55220 CASE# 24-02165 DATE AND TIME 02/27/24 22:23 OF COLLISION i k w a� PAGE 3 OF 3