HomeMy WebLinkAbout24-6296 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
SASE 24-6296 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4900 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# ❑
COLLISION'. 06 - 1-- 2024 1239 17 ❑.= S 8 IN e 1070 3
4❑ oN (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e✓ --- ----� ❑
NE 4TH ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e DUVAL!AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4253065251 0 11
30
6❑ LAST NAME PENTZOLD FIRSTNAME TERESA MIDDLE R 1 1 2 31
INITIAL
STREET ❑ 13038 175TH AVE SE CITY RENTON ST WA ZIP 980598700 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LDRIVER # STATE WA SEX'F MID
.O B 04 1— 14 — 1978 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMETU E 2 CLASS 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� AN15909 sTATe WA urN# 1C4RJFJG3EC189509
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN T GOVT.VEHICLE 3 7 34
13 2014 JEEP GRAND DAMAGE YES 0NO f �AWkkRS vEs❑ No
REGISTERED OWNER INFO SHANE TOLSON 11118175TH AVE SE RENTON WA 98059 D:2062806599 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 956470364 4
IN EFFECT &POLICY# 9TOP
15❑ VEHICLE 1 5 36
LEGALLY YES�No D CITATION# 4A0178126 CHARGE FAIL YIELD LEFT TURN MOTOR io sorroM
STANDING 8 7 6
MOTOR PEDAL-: PEDESTRIAN
16 a YE PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ S 1/ No D:2537338448
LAST NAME XIAO FIRST NAME ASHLEY MIDDLE
INITIAL
17 STREET I❑ s❑' 360 NW DOGWOOD ST APT 0201 CITY' ISSAQUAH ST WA ZIP 980272727 4❑ 37
NEW ADOREs
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs❑NOF YES
❑NO�
19 LDI IVE STATE WA ]SEX IF M DDY
D.C.B.
03 _ 21 2005 39
20❑ ON DUTY STATUS AIRBAG,2 RESTR 4 EJECT 1 HELMET 2 INJURY 7 NATURE of INJURIES ❑ 40
USE CLASS SORE LEG
❑ 41
21❑ ILICENSE PLA E# BLP7610 TATE WA VIN# 4T1BD1FKOCU059196 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 2012 MAKE TOYT MODEL CAMRY STYLE VEHICLE TOWED TO BLIN TOWEDBv GOV HI 44
24❑ DAMAGE YES✓ NO GENE MEYER YES NO
REGISTERED OWNER INFO MEE JANG 360 NW DOGWOOD ST APT 0201 ISSAQUAHWA98027 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO NATIONWIDE 7246JO72885IN STOP 5
VEHICLE ❑ C[ CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N
a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
E.CHANG 10065 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE88253
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6296
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) DAVID AVEIAH B
(IAST FIRST,
ADDRESS&PHONE# D O.B. '
13038 175TH AVE SE RENTON WA 980598700 SEXi F MMDDYyry 08 - 07 - 2019
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ 1 POS. 4 2 10 1 USE 1 2 CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL) :: XIAO NANCY
ADDRESS&PHONE# DOB
360 NW DOGWOOD ST APT 0201 ISSAQUAH WA 98027 2069530689 SEX IF MMDDYvvv 10 - 13 - 2003
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 3 AIRBAG 2 RESTR. 4 EJECT 1 USE 1 2 CLASS 1
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'
I reviewed dash camera footage from unit 2 and it showed unit 2 was driving westbound in lane of NE
4th St approaching Duvall Ave NE. Unit 2 had a green light for a long while. As unit 2 was going
through the intersection of NE 4th St and Duvall Ave NE unit 1 made a northbound turn in front of unit
2 and unit 2 collided with unit 1.
Driver of unit 1 said she had a blinking yellow light and the other vehicle came out of nowhere.
RCW 46.61.185. Vehicle turning left. The driver of a vehicle intending to turn to the left within an
intersection or into an alley, private road, or driveway shall yield the right-of-way. to any vehicle
approaching from the opposite direction which is within the intersection or so close thereto as to
constitute an immediate hazard. Driver of unit 2 did not yield right of way to unit 2.
Unit 1's failure to yield is a contributing factor in the collision.
I cited the driver of unit 1 for Failure to yield left turn motor vehicle.
Driver of unit 2 had a bruised leg.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 06-16-24 11:42 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 1 6/19/2024 2:20:00 PM
BADGE OR ID# 10065 OR]# ': WA0171300 TIME POLICE DISPATCHED 12:39 PM TIME POLICE ARRIVED 12:42 PM
PART I PAGE IT]OF 3�
REPORT NO. EE88253 CASE# ' 24-6296 DATE AND TIME 06/15/24 12:39
OF COLLISION
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