Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout24-5759 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-5759 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI 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#
cawsloN 05 - 1-- 2024 1351 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
S RENTON VILLAGE PL
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e TALBOT RD S
0 1 29
MOTOR PEDAL- DAM THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El YES NO ✓ D:2066888788 0 4 30
6� LAST NAME HUYNH FIRSTNAME VAN MIDDLE N 9 2 31
INITIAL
STREET ❑ 924 E SANDSTROM PL CITy KENT ST WA 2jp, 980303700 z=
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CGG9225 sTArI WAvIN# 5GZCZ63437S803743
10❑ PI ATE 94
IT STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 2 5 33
12 0 0 VIN#' VIN#
>; FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 1 34
13 2 2007 STRN VUE UT DAMAGE YES NO ✓ YES[:] NO✓
REGISTERED OWNER INFO VAN HUYNH 924 E SANDSTROM PL KENT WA 980303700 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO NATIONAL GENERAL 2017469107 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN,DIING 8 7 6
UNIT MOTOVEH OR CYCLE ❑ PEDESTRIAN ❑ OWNER RTY ❑ DYES✓ NO OLD MET PHONE
16 2
LAST NAME BAUMANN FIRST NAME HOLLI MIDDLE I j
INITIAL
17❑ STREET ❑', 17620 SE 259TH CT CITY COVINGTON ST WA ZIP 980428368 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19 D IVEW # STATE WA SEX F M .C.B. 01 21 1989 39
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT '1 USE 2 CLASS ❑
21❑ LICENSE BDW3886 TAre I WA vIN1i JM3KE4CY4G0881130
❑ 41
PLATE#
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2016 MAKE MAZp MODEL CX-5 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YESfj
NO✓ YES NO✓
REGISTERED OWNER INFO HOLLI BAUMANN 17620 SE 259TH CT COVINGTON WA 980428368 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSU&PORGY#E CO GRANGE INSURANCE 5104440084792 I STOP 5
IN EFFECT
vE""LE ❑ N`L J
,J� CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES s a
7CA
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26LAN 12007 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE83101
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5759
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 May 31, 2024, at 1351 hours dispatch requested that I respond to a collision at the intersection of
Renton Village PI S and Talbot Rd S, in Renton.
Upon my arrival I spoke with the driver of unit 2 and she explained that while making a left turn from
Renton Village PI S, she saw unit 1 run a red light and strike her driver side doors.
I then spoke with the driver of unit 1 and he explained that he thought he had a yellow traffic light, so
went through the intersection. He was going southbound on Talbot Rd S from S Grady Way. Initially,
he stated that the other driver struck him, but he recanted that and mentioned the sun blinded him.
He believed he had a yellow light.
Both vehicles sustained moderate damage, and both drivers were given an exchange of information.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.CATALAN 05-31-24 05:18 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 6/3/2024 11:04:07 AM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 1:51 PM TIME POLICE ARRIVED'1:59 PM
PART I PAGE IT]OF 3�
REPORTNO.! EE83101 CASE# 24-5759 DATE AND TIME 05/31/2413:51
OF COLLISION
Y
t
f�y
i
�,�, � ��a, •�Spa ts.?.� .��.
i t
�,� nym:,, �•t t �. �,� .�:" .,ate, .�
x:Y
y
PAGE 3 OF 3