HomeMy WebLinkAbout24-4981 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 2 27c
COLLISION REP FIT 1591971
SASE 24-4981 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4900 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 0 4 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
COLLISION'. 05 — 09 — 2024 1710 17 . N E IN� S 8 W H OF e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S 26TH ST BLOCK NO. e ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e BENSON RD S
0 3 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4254421799 30
6� LAST NAME PUJALET FIRSTNAME JORDAN MIDDLE J 1 2 31
INITIAL
STREET ❑ 11901 SE 167TH ST CITY RENTON ST WA Zlp' 98058 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 2 EJECT 1 H USEET ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� D33801 B sTArI WAurN# 3TMCZ5AN9JM186954
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
TRLR. TRLR 7 5 33
12❑ vIN#' UIN#
:: FROM TO
VEH.YEAR 2018 TOYT TACOM PK MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
❑
SHADE IN DAMAGED AREA ❑ 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE71083237 3 4
IN EFFECT &POLICY# 9TOP
VIC CHARGE 5 36
LECALLEHLEv res❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs NO D:2063139560
16 2
LAST NAME SON FIRST NAME RICHARD MIDDLE
INITIAL
17 STREET NEW ADDREs7 17115 116TH AVE SEA-5 CITY RENTON ST WA ZIP 98058 4❑ 37
18� CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs It I NOF YES t t— l NO❑
19 DRIVE # SEX M M .C.B. 02 _ 02 _ 2012 39
20 ON DUTY STATUS 1 AIRBAG RESTR EJECT 2 H EET 6 CLASSY 6 ABRASION,PAIN,CHIPPED TOOTH ❑ 40
❑21❑ TArE 41
LICENSE VIN# 1
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY Gov HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ C[:] CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 5 0 D.MOYN/HAN 11288 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT No. EE75644
COLLISION REPORT III III III III III 111
1591972 CASE# 24-4981
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 05-09-2024 1 was on routine patrol in a marked patrol vehicle. At about 1716 hours I was in the
area of Benson Rd S and S 26th St when I on viewed a recent vehicle versus bicycle collision.
I contacted the driver of vehicle 1, who was later positively identified via picture matching WA DL
photo as Jordan J Pujalet (DOB 02-08-1988). Pujalet's vehicle was a grey Toyota Tacoma bearing
WALP D33801 B. A summary of my conversation with Pujalet follows. Pujalet was stopped at a red
light on S 26th St preparing to make a right turn to head south on Benson Rd S. Pujalet was looking
north for a gap in traffic and began to turn. As Pujalet was attempting to turn, a cyclist crossed in
front of his truck and was struck. Pujalet estimated he was travelling 2-5 mph as he had just started
moving.
The cyclist was verbally identified as Richard Sun (DOB 02-02-2012). His mother, Vibol Uy (DOB 08-
30-1982) confirmed his identity. Uy was not present at the time of collision, but was called by her son
after and responded to the scene. Sun stated he was riding northbound down the hill. He saw the
light was red so he thought it was safe to proceed into the cross walk when he was hit by the truck.
Sun complained of arm, leg and torso pain. Sun was wearing a helmet, but had a chipped front right
incisor and headache. Sun was evaluated by Renton Fire but declined transport.
Based upon statements from both parties, it appears as though Pujalet's failure to yield in the cross
walk was the proximate cause of the collision. He was given a verbal warning. It should be noted
that Sun did not attempt to stop or slow, and did not utilize the crosswalk signal.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
D.MOYNIHAN 05-10-24 01:31 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
D.MOYNIHAN 1128E 511012024 1:33:04 AM
BADGE OR ID# 111288 OR]# WA0171300 TIME POLICE DISPATCHED 5:16 PM TIME POLICE ARRIVED 5:16 PM
PART I PAGE IT]OF 3�
REPORT NO. EE75644 CASE# ' 24-4981 DATE AND TIME 05/09/24 17:10
OF COLLISION
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