HomeMy WebLinkAbout24-7655 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-7655 z
INTERSTATE ❑ CITY STREET ❑ FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 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# ❑
cowsloN 07 - 1-- 2024 1346 17 ❑.= S 8 E IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
N LANDING WAY BLOCK NO. e✓ 900
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5 250 00 FMILES EET e S ❑ E e LOGAN AVE N
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:4259198488 0 11
30
6� LAST NAME TU FIRSTNAME THANH MIDDLE T 1 1 2 31
INITIAL
STREET ❑✓ 7212 S 116TH ST CITY SEATTLE ST WA ZIP 98178 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NO 1/ 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 9❑ Pi aT�S� CNB7042 sTArr WAurN# JTJDGKCA8K2007716
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# FROM TO
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 7 $ 34
13 9 2019 LEXS RX 300 SW DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA ❑ 35
14 LIABILITY INSURANCE INSURANCE CO MUTUAL OFENUMCLAW AB30079579 3 4
IN EFFECT &POLICY# STOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:2062906010
16 a
LAST NAME PARKS FIRST NAME AMY MIDDLE E
INITIAL
17❑ STREET ❑', 974 ANA 98059CORTES CT NE CITY RENTON ST WA ZIP 37
NEW ADDRESS ❑
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL TRANSPORTED 38
INTERLOCK YEs❑No� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER'S STATE WA ]SEX IF D.O.B. 10 _ 05 _ 1977 39
LICENSE# MMDDYY
WELMET INJURY1 NATURE OF INJURIES 40
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑
21❑ LICENSE I CEB1781 TAre WA vIN# 1VWBS7A37FC014177
❑ 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ VIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2015 MAKE VOLK MODEL PASSAT STYLE 4D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO WILLIAM DEAN 974ANACORTES CTNE RENTONWA98059 D:2069418908 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE &POINSURGY#E CO STATE FARM 524 9975-C22-47IN 1 STOP 5
VE""LE ❑ Nu,J CITATION# CHARGE i o BOTTOM
LEGALLY YES
25 $ '
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PAGE 01 OF
PART A
3000-345-159 fR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EE97719
COLLISION REPORT III III III III III 111
1591972 CASE# 24-7655
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) CREDIT MAYA R
(LAST FIRST,
ADDRESS&PHONE# D O.B. '
1700 UNION AVE NE RENTON WA 98059 2067479183 SEXi F MMDDYyry 01 - 10 - 2007
PASSENGER WITNESS UNIT# 2 PEA 3 AIRBAG J 2 RESTR. q EJECT ? 1 HELMET INJURY NATURE OF INJURIES
USE CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) DEAN MALAYA E
ADDRESS&PHONE# DOB
974 ANACORTES AVE NE RENTON WA 98059 2062019448 SEX F MMDDYyvv 07 _ 09 _ 2006
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER WITNESS UNIT# 2 POS 9 AIRBAG 2 RESTR. 4 EJECT 1 USE 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'
Unit 1 driving south on private driveway through lot. Unit 2 eastbound on intersecting private driveway
through lot. Unit 1 left front corner struck unit 2 left rear side, at left rear corner. Driver 1 Tu believed
that unit 2 was speeding, but acknowledged that he did not see unit 2 at all prior to collision. Unit 2
driver Parks said that she was crossing intersection when unit 1 approached and hit her car without
slowing. Private property collision, no citations/infractions issued. No injuries to drivers or both unit 2
passengers.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 07-20-24 03:25 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
QUINT TIBEAU 07691 1 712112024 7:04:09 AM
BADGE OR ID# ( 5738 OR]# WA0171300 TIME POLICE DISPATCHED! 1:55 PM TIME POLICE ARRIVED'Y:00 PM
FART I PAGE IT]OF 3�
REPORT NO. EE97719 CASE# ' 24-7655 DATE AND TIME 07/20/24 13:46
OF COLLISION
*00
4�
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