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HomeMy WebLinkAbout24-8697 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c COLLISION REP FIT 1591971 SASE 24-8697 2 INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHIr.I 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 CITY# ❑ COLLISION'. O8 - 18 - 2024 1320 17 ❑.❑ N E IN S 8 W H OF e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NE 12TH ST BLOCK NO. e✓ 2500 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 250 00 FMILES EET e S ❑ W e EDMONDS AVE NE 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLDHONE UNIT 01 VEHICLE ❑ CYCLE El MET P YES �/No D:2064347786 1 5 30 6� LAST NAME ZHAO FIRSTNAME QIUSHENG MIDDLE 1 2 31 INITIAL STREET ❑, 1900 NE 16TH ST CITY RENTON ST WA ZIP 98056 z NEW ADDRESS ]❑ 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 H U SE ICNLJAUSSY 1 NATURE OF INJURIES z❑ 3 10 9❑ PI ATFBit BYJ1558 sTArI WA urN#' 2HKRW2H85MH615986 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FROM TO TRLR. TRLR 3 7 33 12 2 5 VIN#' VIN# >; FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 0 O 34 13 2 2021 HOND CR-V EX UT DAMAGE YES NO YES[:] No✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1 SHADE IN DAMAGED AREA ❑ 35 14 LIABILI INSURANCE INSURANCE CO PROGRESSIVE 969791424 IN EFFECT z &POLICY# 9TOP vECALLv Hla.e 5 36 YES❑NO❑ CITATION# CHARGE 10 BOTTOM 15❑ LE STANDING 8 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:3053947903 16 a LAST NAME W/N FIRST NAME KEON MIDDLE C INITIAL 17❑ STREET �', 1140 EDMONDS AVE NE#226 CITY RENTON ST WA ZIP 98056 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 M D.C.B. 09 _ 07 1998 39 LICENSE# MMDDYY WELMET INJURY1 NATURE OF INJURIES 40 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 USE CLASS ❑ 21❑ LICENSE BUJ5073 TAre I WA YIN# 2HGFC2F74HH503959 ❑ 41 PLATE# 42 22❑ PLATE# STATE PLATE ILER# STATE TRLR 23❑ VIN#. IN#. 43 RLR ' TOWED BY Gov HI 44 VEH YEAR 2017 MAKE HOND MODEL CIVIC STYLE $D DAMAGE TOWED NOO✓ BLIN YES NO 1/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSU&PORGY#E CO STATE FARM 529 0162-E29-47IN 1UQI 'E""LE ❑ ,J� CITATION# CHARGELEGALLYYES N`L J25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 R.ON/SHl 5738 WA0171300 PART A PAGE 01 OF C7 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF08336 COLLISION REPORT III III III III III 111 1591972 CASE# 24-8697 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME MIDDLE INITIAL) TAMURA JAEDI K (LAST FIRST, ADDRESS&PHONE# D O.B. ' 1140 EDMONDS AVE NE#226 RENTON WA 98056 SEXi F MMDDYyry 01 - 23 - 2001 PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES ❑✓ ❑. 2 POS, 3 2 4 1 USE CLASS 1 NAME '(LAST,FIRST MIDDLE INITIAL) ADDRESS&PHONE# DOB SEX MMDDYYYV PASSENGER ❑WITNESS❑ UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. USE CLASS NAME (LAST FIRST MIDDLE INITIAL) AppRESS R PHONE# SEX D.O.B.MMDD -❑ YYYY. PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. USE CLASS ----� NARRATIVE' Unit 1 westbound on NE 12th St, unit 2 facing westbound on NE 12th St attempting to parallel park. Unit 1 right side struck unit 2 left front corner. Driver 1 Zhao claimed that unit 2 was pulling out of space, not parking; I did note that at the end of my contact, driver 2 Win and passenger Tamura were unloading apparent shopping purchases and walking to their nearby apartment, consistent with their account. I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. R.ONISHI 08-18-24 02:43 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE QUINT TIBEAU 07691 1 8/25/2024 2:08:21 PM BADGE OR ID# ( 5738 OR]# WA0171300 TIME POLICE DISPATCHED ?:38 Pry] TIME POLICE ARRIVED',1:40 PM FART Ei PAGE ❑OF❑ REPORT NO. EF08336 CASE# ' 24-8697 DATE AND TIME 08/18/24 13:20 OF COLLISION i t. "i PAGE 3 OF 3