HomeMy WebLinkAbout24-8643 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-8643 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AOENC 4Y00 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'. OS - 1-— 2024 1757 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
e✓ --- ----�
S 3RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5 MILES S❑ 100 00 FEET e ❑ E e SHATTUCKAVES
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:2068773539 0 11
30
6� LAST NAME DANG FIRSTNAME VAN MIDDLE M 1 1 2 31
INITIAL
STREET ❑ 7720 HIGHLAND PARK WAY SW CITY SEATTLE ST WA 2jp, 98106 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
LICENSE CLE4253 sTArI WAurN# JTME6RFV3RJ048093
10 F91 PI ATE#
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED By GOVT.VEHICLE 7 $ 34
13 1 2024 TOYT RAV4 UT DAMAGE YES NO ves❑ No
REGISTERED OWNER INFO VAN DANG 7720 HIGHLAND PARK WAY SW SEA TTLE WA 98106 D:2068773539 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILI INSURANCE INSURANCE CO SAFECO H2544830 3 4
IN EFFECT &POLICY# 9TOP
VEF" 1 5 36
LEGALLY
Yes[:1 No❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING 8
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2067750080
16 a
LAST NAME DIEGO-PASCUAL FIRST NAME MATEO MIDDLE ,/
INITIAL
17❑ NEW ADDRE— 3707 S STREET 150TH ST APT D CITY TUKWILA ST WA ZIP 98188 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK vEs I I NOF YEs t l NOF,/
19 DRIVERS#
❑ ON DUTY STATUS I
AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CFU4893 TArE 41
WA vIN1 2C4RC1DG3MR508955 1
42
22❑ PILER LATE# STATE pLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
GI
VEH D
YEAR 2021 MAKE CHRY MODEL VOYAGE STYLE VN AMAGE TOWED ES NOO✓ BLIN TOWED By ovyES NO 1/ 44
H
24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE❑ INSURANCE CO NA
IN EFFECT &POLICY# I 9TOP 5
VEHICLE ves� N� CITATION# CHARGE OP MOT VEH W/OUT INSURANCE, to BOTTOM
LecALLv `LJ
25 s a
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEV/N PETERSON 12808 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF06207
COLLISION REPORT III III III III III 111
1591972 CASE# 24-8643
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 NJURY 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'
I was dispatched to a collision on 08/16/24 at 1800 hours S 3rd St and Shattuck Ave S, in city Renton,
King County WA.
Unit 1 CLE4253 Driver: Van M. Dang (DOB 11/20/1966)
Unit 2 CFU4893 Driver: Mateo J. Diego-Pascual (03/03/1980)
Unit 2 was traveling in lane 1 going East on S 3rd St approaching Shattuck Ave S when Unit 1 turned
into his lane hitting the passenger side front of his van. He said she looked as if she was going to turn
into the restaurants parking lot. Unit 1 was traveling in lane 2 going East on S 3rd St when she
attempted to turn into lane 1. When merging left into the lane she stated Unit 2 was driving to fast and
that Unit 2 hit her.
Both drivers denied medical attention on scene and reported no injuries.
I gave information exchange to both drivers.
Upon request Mateo was unable to provide proof of insurance that was valid and was cited for driving
a motor vehicle without insurance. Mateo had a driver's license that was suspended or revoked in the
third degree and was cited for driving a vehicle while his license was suspended.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
KEVIN PETERSON 08-17-24 12:40 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 888 1 811812024 9:50:02 PM
BADGE OR ID# ! 1Y808 ORI#' WA0171300 TIME POLICE DISPATCHED 6:00 PM TIME POLICE ARRIVED 6:02 PM
PART I PAGE IT]OF 3�
REPORT NO. EF06207 CASE# ' 24-8643 DATE AND TIME 08/16/24 17:57
OF COLLISION
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