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HomeMy WebLinkAbout24-10651 j ITFC II IIIII III IIIII II IIII IIIII I . 27I OOLCERAF EF25112 COLLISION REPRT 1591971 CASE# 24-10651 2 INTERSTATE CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOt'ALNENCY. 4100 3 COUNTY RD INVOLVED CODING PRIVATE WAY 2❑ TRIBAL TOTAL 1 UNITS#OF 02 SO BJECT TRUCK 1 8 28 RESERVATION 2 3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# DATE OF'. N E coLLISION' 10 - 11 - 2024 2259 17 =.= S 8 W E OF IN M 1070 a 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ NE SUNSET BLVD BLOCK ST e 1000 .= 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET S 8 W e NE 10TH ST 0 4 29 MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4255205943 0 1 30 6 LAST NAME TANG FIRST NAME JANE MIDDLE 1 2 31 INITIAL STREET ❑ 14707 SE 46TH ST CITY I BELLEVUE ST WA ZIP 980062442 2 NEW ADDRESS 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 INTERLOCK YES NO✓ INTERLOCKYEs NO✓ YEs Nor,/ 8� LCEENSE# STATE WA SEX F MDmopyy' O6 - 18 - 2002 1 2 32 9 ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 N USEET INJURY CLASS 1 NAruRE of INJURIES 2 LICENSE, CNE0645 STATE WA VN# 5J6RW2H51KA012862 3 10 PI ATP rt TRAILER STATE TRAILER ,STATE 11 2 5 PLATE# PLATE# ROM TO TRLR TRLR 3 5 33 1 2 ( FROM TO 2 5 VIN# VIN# VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWEDBY GOVT VEHICLE 13 4 2019 HOND CRV SV DAMAGE YES DNO ✓ YEs❑ No✓ 7 3 34 REGISTERED OWNER INFO JOYCE TANG 14707 SE 46TH ST BELLEVUE WA 980062442 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 LIABILITY INSURANCE❑ INSURANCE CO 3 4 14 AMER FAM CONN CASUALTY AIOf4035250 IN EFFECT &POLICY# 4TOP VEHICLE CHARGE 5 36 Lemur YES[:]NO[:] CITATION# 7 o BOTTOM 15❑ nNowc e MOTOR PEDAL- PROPERTY DAM THR OLD MET PHONE UNIT 02 Q ❑ PEDESTRIAN ❑ D:2069727359 VEHICLE CYCLE nWNPR YES✓ NO 16� LAST NAME CASTRO FIRST NAME MARCOS MIDDLE' P INITIAL 37 17 STREET'❑ 11735 64 ❑TH LN S CITY SEATTLE ST, WA ZIP 981782918 NEW ADDRESS 18❑ CDL IGNITION REQUIRED IGNTION PRESENT MEDICALTRANSPQRTED 38 INTERLOCKYEs No✓ jNTERLO DK YES NO✓ rEs No;✓ 19 DRIVER'S STATE WA sEX M D.O.B. 03 29 2008 ❑ 39 LICENSE# MMDDYY - HELMET INJURY' NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑ 21 LICENSEPLATE# EHU340 rare AK vIN# 5TEWN72N93Z233179 41 22❑ [TILER AILER PLATE# STATE PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2003 MAKE TOYT MODEL TgCOMA STYLE TR VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO AUDREY CASTRO4129 COL..JUNEAU AK 99801 VEHICLE NO,2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO STATE FARM 1714921D1403 IN EFFECT &POLICY# `HiaE CITATION11 CHARGE LecnLLYYE❑ N 25 t M OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 HANSEN HSU 12651 WA0171300 PART A PAGE 01 OF 11 3000-345-159(R 11/181 POLIICFETRAFFICN CORRECTION REPORT NO. EF25112 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10651 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL} CASTRO VERONICA (LAST,FIRST ADDRESS&PHONE# DOB 11735 64TH LN S SEATTLE WA 981782918 9077235558 SEX'. F MMDDYYYv 02 — 04 — 1983 SEAT HELMET INJURY NATURE OF INJURIES PASSENGER WITNESS UNIT# 2 POS. 3 AIRBAG(2 RESTR. 4 EJECT 1 USE CLASS 7 TORSO PAIN 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B.M —� MDDYYYY PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. —� II MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR, EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. CLASS NARRATIVE Unit 1 traveling west on NE 10th St at the intersection of NE Sunset Blvd. Unit 2 traveling east on NE 10th St at the intersection of NE Sunset Blvd. Unit 1 fails to yield right of way when making a left turn, southbound onto NE Sunset Blvd causing reportable non disabling front end damage to Unit 1 and reportable disabling front end damage to Unit 2. No injuries reported save for passenger of Unit 2 who complained of torso pain and was treated on scene by Renton Fire. Unit 1 driver was proximate cause of vehicle collision. Both units were hobbled into a private parking lot adjacent to the intersection to clear the roadway. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. HANSEN HSU 10-12-24 12:28 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE P.SUMMERS 8887 10/16/2024 4:27:15 PM BADGE OR ID# 12651 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 11:01 PM TIME POLICE ARRIVED 11:03 PM PART IS 3aaa-345-,aa(R11Y1s) PAGE 27OF 37 REPORT NO. EF25112 CASE# 24-10651 DATE AND TIME 10/11/24 22:59 OF COLLISION Oq MCI is c� e 5 i S d ") J max` } �t. alb t, s, 2 } Sr J v v_ S t t t PAGE 3 OF 3