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HomeMy WebLinkAbout24-6395 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-6395 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 2 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 CITY#
COLLISION' 06 - 18 - 2024 0911 17 . N E IN� S 8 W H OF 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 ❑ W e DUVAL!AVE NE
0 4 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2065307382 0 11
30
6� LAST NAME WILSON FIRSTNAME CHAYLIA MIDDLE C 1 1 2 31
INITIAL
STREET ❑ 7756 37TH AVE S CITY SEATTLE WA
NEW ADDRESS ST 21P 981184006 z
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO INTERLOCKYEs NO YES R NO
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ P1 aT�S� BUE5202 sTAT� WA urN# 1C4RDHEG8EC286797
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR. 7 1 33
12 3 5 VIN#j VIN#'
FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 ] 34
13 r 2014 DODG DURAN DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO CHAYLIA WILSON 175637TH AVE S SEATTLE WA 981184006 D:2065307382 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 ❑ INSURANCE CO
LIABILITY INSURANCE
IN EFFECT &POLICY# 9TOP 5
ve'CLE CHARGE 10 BOTTOM 36
LEGALLY YES No CITATION# 4A0361526,4A0361526, FL RENEW EXPIRED REG<=2 MTHS,
15❑ NDING 8 6
MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE
UNIT a2 VEHICLE CYCLE ❑ PEDESTRIAN ❑ OWNER ❑ YES 1/ NO D:5306010937
16 a
LAST NAME LI FIRST NAME GUOZHEN MIDDLE N
INITIAL
17❑ STREET ❑', 5417 NE 6TH ST CITY RENTON ST WA ZIP 980594984 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES�NOF INTERLOCK YEs It I NOF YES
t t- l NO❑
19 F] D IVEW # STATE WA SEX M M D.C.B. 12 _ 16 _ 1989 El 39
WELMET INJURY NATURE OF INJURIES 4O
20❑ ON DUTY STATUS AIRBAG 6 RESTR 4 EJECT 1 USE I CLASS 1 ❑
21❑ LICENSE A7346382 TATe I WA VIN1t Y►/4102WK5M1075055
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2021 MAKE VOLV MODEL V60 STYLE VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES✓ NO BANKERS YES NO
REGISTERED OWNER INFO GLI.Ll 5417 NE 6TH ST RENTON WA 980594984 D:5306010937 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU8 PORGY#E CO ALLSTATE 817 901 125IN 9TOP 5
VE""LE ❑ Nu,J CITATION# CHARGE io BOTTOM
LEGALLY YES
25 ' e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.lEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE89713
COLLISION REPORT III III III III III 111
1591972 CASE# 24-6395
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'
Please see subsequent narrative pages
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 06-18-24 11:36 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
C.JACOBS 1953 6/24/2024 12:16:42 PM
BADGE OR ID# 2517 OR]#' WA0171300 TIME POLICE DISPATCHED; 9:13 AM TIME POLICE ARRIVED',9:27 AM
PART I PAGE IT]OF 4�
REPORT NO. EE89713 CASE# 24-6395 OF COLLISION
06/18/24 09:11
OF CbLLI510N
NARRATIVE
blk suv It yellow blink wht suv /2 lane 1 green
CC
Within the city limits of Renton/King/WA I responded to a 2 car crash at the intersection of NE 4th St
at Duvall Ave NE.
I contacted the driver of unit 2 who told me he was west bound lane 1 on NE 4tb St on his green light
when unit 1 turned left across his path without room to avoid contact. He did mention his knee was
sore, but refused any kind of medical attention. His vehicle was impounded for damages.
I contacted the driver of unit 1 ID'd by his picture WADL. She told me she was turning left on the
flashing yellow arrow when the collision took place. She told me she was not hurt from the crash but
had an underliining issue and was checked by Renton Flre on scene. She told me that she was
between insurance companies at the moment and was unable to provide valid proof, also a
DOI/WACIC check revealed her registration was expired 05-18-2024. Her tabs dispalyed 5-2024.
Although her car required a tow truck she chose to leave it in a near by parking lot.
I cited Wilson/Unit 1 ref RCW 46.61.185 FTYROW left turn two car crash, Ref RCW 46.30.020 No
Insurance and Ref RCW 46.16A.020 Expired Tabs via complaint.
Unit 2 provided a video that showed he was on his solid green light at the time of the crash.
PAGE 3 OF 4
REPORT NO. EE89713 CASE# 24-6395 DATE AND TIME 06/18/24 09:11
OF COLLISION
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