HomeMy WebLinkAbout24-5766 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
SASE 24-5766 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 5 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 05 - 1-- 2024 1547 17 ❑-= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BRONSON WAY
BLOCK NO. e✓ --- ----� ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ VV a MAIN AVE S
1 2 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:9852860079 0 11
30
6 LAST NAME SOLORIO FIRSTNAME JULIE MIDDLE B 1 1 2 31
INITIAL
STREET ❑ 615 27TH ST CITY HOQUTAM WA
NEW ADDRESS ST 2jp 985504104 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10❑ P1 aT�S� CDW5351 sTArI WAvIN# 1C4PJMBXOKD131244
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FR.. ro
TRLR. A'RLR. 1 5 33
12 0 0 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 1 $ 34
13 2 2019 JEEP CHERO DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO JULIE SOLORIO 61527TH ST HOQUTAM WA 985504104 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO NATIONAL GENERAL 2023047687
IN EFFECT &POLICY#POLICY 9TOP
CHA
VEwcLE RGE 5 35
LECALLv res❑NO❑ CITATION# 1 o BOTTOM
❑ STANDING
15 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YEs No ,/ D:206445270
16 a 5
LAST NAME PHOUSOUVANH FIRST NAME SOUPHY MIDDLE N
INITIAL
17❑ STREET ❑', 1221 LYONS AVE NE CITY' RENTON ST WA ZIP 980596041 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOR INTERLOCK Y�EsI I I NOF YES
t l NO❑
19 DRIVER'S STATE WA SEX M D.C.B. 03 _ 25 _ 1979 39
LICENSE# MMDDYY
HELMET {NJURY 1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE 2 CLASS ❑
21❑ LICENSE I C27334G TAre WA YIN# 1FTNX21S8YEE31780
❑ 41
PLATE#
42
22❑ PLATE# STATE TILER PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2000 MAKE FORD MODEL F250 STYLE UT VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO SOUPHYPHOUSOUVANH 1221 LYONS AVE NE RENTON WA 980596041 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU8 PORGY#E CO AMERICAN FAMILY INSURANCE BX10075666 STOP 5
IN EFFECT0(
'E""LE ❑ ,J� CITATION# CHARGE io BOTTOM
LEGALLY YES N`L J
25 ' 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. EE83102
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5766
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 1547 hours dispatch requested that I respond to a collision at the intersection of
Main Ave S and S 2nd St, in Renton.
Upon my arrival I spoke with the driver of unit 2 and he explained that while driving southbound on
Main Ave S from S 2nd St, the vehicle beside him slowly began to merge into his lane. His wheels
began to rub against the passenger side door of unit 1. Eventually he slowed his vehicle down, but
unit 2 swung in front of his vehicle.
I then spoke with the driver of unit 1 and she explained that her vehicle struck unit 2 damaging her
passenger side doors.
The driver of unit 2 was unsure on how the collision occurred, but both vehicles sustained moderate
damage. I provided the two drivers with 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 11:06:34 AM
BADGE OR ID# 1Y007 ORI# WA0171300 TIME POLICE DISPATCHED 4:08 Pry TIME POLICE ARRIVED 4:08 Pry
PART I PAGE IT]OF 3�
REPORT NO. EE83102 CASE# 24-5766 DATE AND TIME 05/31/2415:47
OF COLLISION
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