HomeMy WebLinkAbout24-5767 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-5767 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4250 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 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# ❑
GawsloN 05 - 1-- 2024 1527 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK NO. e✓ --- ----�
RENTON EXT MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 800 00 FEET MILES e S ❑ W e SW V/CTOR/A
2 0 29
MOTU '�01 VEHtOCLEZ PEAL-CYMLE. El �ESAGE NHORE✓LD MET PHONE 0 1 30
6� LAST NAME UNKNOWN FIRSTNAME MIDDLE 1 1 2 31
INITIAL
STREET ❑ CITY ST ZIP 2
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNIT{ON PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCK YES NO YES No
8❑ LIRCIENSRE#
STATE I
SEX u MMDDYY - 1 1 2 32
9 ON DUTY❑ STATUS I
AIRBAG 9 RESTR 9 EJECT 1 H U EEr 9 CLAY 0 NATURE OF INJURIES z❑
3
LICENSE sTATI urN#'
10[ PI ATE#
C7
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM ro
TRLR 5 7. TRLR 33
12 3 5 vIN# VIN#
FROM TO
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
13 2 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO [NEW] VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LABILI INSURANCE❑ NSURANCE CO 3 4
IN EFFECT &POLICY# 9TOP
VEwcLE 5 36
LECALLv YES❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2064128483
16 a
LAST NAME NGUYEN FIRST NAME HOANG MIDDLE IT
INITIAL
17 STREET I❑ 11268 57TH AVE S CITY' SEATTLE ST' WA ZIP 98178 37
NEW ADOREss❑'
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL t—T�RANSPORTED ❑ 38
INTERLOCKYES�NO� INTERLOCK YEs I I No� YES t l NO❑
19 LDICENS STATE WA SEX U MMDDYY O6 _ 22 _ 2002 El 39
HELMET I {NJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
❑ILICENSE 21❑ PLA E# BYR6788 TATe 41
WA vIN# JH4CU4F63AC800035 4
42
22 [TRAILER TILER
❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
UIN#. 'IN#.
VEH YEAR 2010 MAKE ACUR MODEL TSX STYLE VEHICLE TOWED TO BLIN TOWEDeY GOV HI 44
24 DAMAGE YES NO GENE MEYER YES NO
REGISTERED OWNER INFO XUAN NGUYEN 1126857TH AVE S SEATTLE WA 98178 D:2064128483 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
INAEFFIECTTY NSURANCE INSU&POLICY#E CO SAME. 1 9TOP 5
VETILE S❑ N Ell
CITATION# CHARGE i o BOTTOM
LEGALLY YE
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# 777T�NCY
26
M.LEVERTON 2517 0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE85811
COLLISION REPORT III III III III III 111
1591972 CASE# 24-5767
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'
blk something merge from victoria into unit 2 tan sedan
RTF
Within the city limits of Renton/King/WA I responded to a 2 car hit and run crash near Renton Ext and
Victoria Ave.
I contacted the driver of unit 2 about 1/2 mile west of that intersection. He was blocking WB lane one.
He told me that a black some type of vehicle, no further description, merged from Victoria Ave and
crashed into the side of his vehicle and fled the area. Unit 2 told me he lost control of his vehicle after
impact, did not want to driver and requested to have his vehicle impounded. He did not complain of
injury and damages did not appear to require a tow truck.
information/Insurance only
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 6/4/2024
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 06-04-24 10:03 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 6/12/2024 7:26:01 AM
BADGE OR ID# 2517 ORI#' WA0171300 TIME POLICE DISPATCHED 3:32 PM TIME POLICE ARRIVED 3:52 PM
PART I PAGE IT]OF 3�
REPORTNO.! EE85811 CASE# 24-5767 DATE AND TIME 05/31/2415:27
OF COLLISION
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