HomeMy WebLinkAbout24-3214 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 1 27c
COLLISION REP FIT 1591971
CASE 24-3214 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 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#
cowsloN 03 - 1-- 2024 0749 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 1200 ❑
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 12 ST NE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
No ,/ I D:4255917249 0 11
30
6❑ LAST NAME NGUYEN FIRSTNAME BARBARA MIDDLE 1 2 31
INITIAL
STREET ❑ 355 GRAHAM AVE NE CITY RENTON ST WA 2jp, 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO,/ INTERLOCKYEs NO�/ YEs No�/
8❑ LDRIVER # STATE WA SEX'F MMDDYY 02 - 12 - 1975 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE CLASS 2 CLASS 1 NATURE OF INJURIES z❑
3
10[1LICENS P1 ATE 14 CKV6639 sTAr WAu N# 7SAYGDEE5PF964182
5 TRAILER STATE TRAILER STATE
11
3—LATE# PLATE# FROM To
TRLR. TRLR 7 3 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 2023 TESL Y SD DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO gAR.RA NGUYEN 355 GRAHAM AVE NE RENTON WA 98059 D:4255917249 VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA 35
4 INSURANCE CO 4
14 IN EF IT INSURANCE AMERICAN FAMILY CONNECT AX01035548
IN EFFECT &POLICY# 9TOP
VEH'CL' CHARGE 1060TTOM 5 36
LEGALLY, YES❑NO❑ CITATION# 5
15❑ STANDIN 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2533322603
16 2
LAST NAME MITTON FIRST NAME JEREMY MIDDLE D
INITIAL
17 STREET I❑ 238 PELLY AVE N CITY RENTON ST WA ZIP 98057 37
NEW ADDREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 D IVEW # STATE WA SEX M Mr D.O.B. 02 _ 01 1980 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CGJ5154 TArE 41
WA VIN1i SADHC2S13L1F88364 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE JAGU MODEL I STYLE SD VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO,� YES NO
REGISTERED OWNER INFO JEREMY MITTON 238 PELL Y AVE N RENTON WA 98057 D:2533322603 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE I PORGY#E CO STATE FARM INS 542 8058 C16-47IN 1 5—'LLe ❑ ,J� CITATION# CHARGE
25 UQ,
LEGALLY YES N J
=AS
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 GOODWIN 12884 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF61364
COLLISION REPORT III III III III III 111
1591972 CASE# 24-3214
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(/AST 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'
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.
NICHOLAS GOODWIN 03-25-24 10:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
CASEY PROCTER 12123 21112025 1:37.10 AM
BADGE OR ID# 12884 OR]# WA0171300 TIME POLICE DISPATCHED; 7:49 AM TIME POLICE ARRIVED',7:52 AM
PART I PAGE IT]OF 4�
REPORT NO. EF61364 CASE# 24-3214 OF COLLISION
03/25/24 07:49
OF CbLLI510N
NARRATIVE
24-3214
Unless otherwise noted, the following took place within the city limits of Renton, County of King, WA.
On 03/25/2024 at approximately 0751 hours, I was dispatched to non-injury motor vehicle accident at
the intersection of NE Sunset Blvd / 12th St NE.
I arrived on scene and contacted two vehicles parked along the right shoulder of 12th St. NE, facing
southbound. The drivers of both vehicles were out of their vehicles and appeared uninjured.
Vehicle #2, a gray 2023 Tesla Model Y (WA/CKV6639 and VIN: 7SAYGDEE5PF964182), was in front
of vehicle #1, a white 2020 Jaguar I-Pace (WA/CGJ5154 and VIN: SADHC2S13L1F88364). I briefly
contacted the drivers and asked them to relocate to the Walgreens parking lot.
I contacted driver#2, identified as Barbara Nguyen (02/12/1975) and verified via WA DOL, who
advised she was uninjured. She advised she was traveling southbound through the above
intersection and had a green light. She stated she was passing through the intersection and was
struck by another vehicle on the passenger side of her vehicle.
I contacted driver#1, identified as Jeremy D. Mitto (02/01/1980) and verified via WA DOL. Jeremy
was driving with his wife and baby, and Jeremy advised everyone was uninjured. Jeremy advised he
was stopped at a redlight, facing westbound on NE Sunset Blvd. Jeremy advised he was assisting his
wife in trying to tend to their baby in the back seat of the vehicle. Jeremy said in doing so, he removed
his foot from the brake pedal, causing him to roll into the intersection. Jeremy rolled into the
intersection at idle speeds and struck Barbara's vehicle as she was passing through.
I completed sector collision forms and provided both Barbara and Jeremy copies of the exchange of
information form.
Both parties requested tow trucks on their own accord. Driver#1 attempted to contact their own
insurance tow but were unsuccessful. Driver#2's vehicle was drivable, but she did not want to cause
anymore damage.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
Electronically signed by Officer N. Goodwin 12884 at 1012 hours on 03/25/2024 in Renton, WA.
PAGE 3 OF 4
REPORT NO. EF61364 CASE# 24-3214 DATE AND TIME 03/25/24 07:49
OF COLLISION
14
a
1
1
.r
`s
1 , a
E
S�3
off„
t� �I
PAGE 4 OF 4
