HomeMy WebLinkAbout24-9638 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 24-9638 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 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 N E IN CITY# ❑
COLLISION'. 09 - 1-— 2024 1703 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
MONSTER RD SW BLOCK NO. e✓ 601
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 200 00 FMILES EET e S B W e OAKESDALE AVE SW
2 0 29
MOTOR PEDAL- DAMAGE THRESHOLDHONE
UNIT 01 VEHICLE ❑ CYCLE El MET P
YES
�/No D:2064321525 0 11
30
6� LAST NAME GU FIRSTNAME RUIRONG MIDDLE N 1 1 2 31
INITIAL
STREET ❑ 5848 110TH AVE SE CITY BELLEVUE ST WA Zlp 980062616 z
'NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES[:]NOW INTERLOCKYEs NO Z/ YES R No�/
8 LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNLJAURY 1 NATURE OF INJURIES z❑
3
10� pl ATFBit BMX2280 sTATe WAurN# JTDKARFU6J3054682
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 8 2018 TOYT PRIUS DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO BE/ZH1218144TH AVE SE BOTHELL WA 98021 D:2064321525 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO GEICO 6046-78.16.02 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY
Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
16 a UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2062519965
LAST NAME NEVERS FIRST NAME AYANA MIDDLE I L
INITIAL
17 STREET❑ NEW ADOREss❑' 9428 51 STAVES CITY SEATTLE ST WA ZIP 981185411 37
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED � 38
INTERLOCKYEs❑No� INTERLOCK ves No� YEs NDF
19 LDI IVERI # STATE WA ]SEX IF M DDY
.C... 09 _ 24 1974 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAU EY 1 NATURE OF INJURIES 40
❑21❑ PLATE# DP68905 TATE 41
WA VIN# 2GCEK19K7R1103248 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ VIN#. IN#. 43
RLR
'
VEH YEAR 1994 MAKE CHEV MODEL SILIVERA STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI �44
24❑ DAMAGE YES NO,/ YES NO
REGISTERED OWNER INFO DON WALKER 6931 S 123RD STA118 SEATAC WA 98178 D:2062519965 VEHICLE NO.2
SHADE IN DAGED AREA
2 4
INAEFFITY ECTNSURANCE❑ &POINSULICY#E CO I 9TOP 5
VEHICLE ❑ ,.I—I CITATION# CHARGE i o BOTTOM
LEGALLY YES N
25 s e
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TAGNE 12575 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF16913
COLLISION REPORT III III III III III 111
1591972 CASE# 24-9638
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME(/AST FIRST,MIDDLE INITIAL) ZH/ BEI N
ADDRESS&PHONE# D O.B.
5848 110TH AVE SE BELLEVUE WA 980062616 2064321525 SEX F MMDDYyYv 01 - 07 - 1989
PASSENGER I�I WITNESS UNIT# 1 PEA 3 AIRBAG 2 RESTR. 4 EJECT ? 1 HELIVET INJURY NATURE OF INJURIES
L�!1 USE CLASS 1
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE# BEd MMDDYYYY DOB
PASSENGER ❑WITNESS UNIT# SEAT I AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS&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.
P.LANTAGNE 09-19-24 09:24 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
DESIREE SCOTT 10272 1 9/21/2024 5:44:13 AM
BADGE OR ID# 12575 ORI#' WA0171300 TIME POLICE DISPATCHED 5:30 PM TIME POLICE ARRIVED i 5:35 PM
PART Ei PAGE IT]OF 4�
REPORT NO. EF16913 CASE# 24-9638 OF COLLISION
09/13/24 17:03
OF CbLLI510N
NARRATIVE
24-9638
On 09/13/2024 at approximately 1703 hours, I, Officer Lantagne, responded to a blocking, non-injury
collision which occurred in the 600 block of Monster RD SW, which is located in the City of Renton,
County of King, and the State of Washington. I responded in my fully marked police vehicle, wearing
my patrol uniform.
I arrived on scene and observed Unit#1, a 2018 Toyota Prius with license plates BMX2280 issued
out of Washington State, and Unit#2, a 1994 Chevrolet Silverado with license plates DP68905
issued out of Washington State, blocking the center two-way left turn lane. I was advised there were
no injuries.
I contacted the driver of Unit#1, Ruirong Gu (DOB 11/16/1964), who told me the following: Gu was
driving northbound on Oakesdale AVE SW. As Gu's vehicle continued north the road merged into
Monster RD SW and into a single lane following a roadwork area with cones. Gu attempted to merge
into the center two-way left turn lane to make a U-turn, and Unit#2 accelerated to pass Gu's vehicle
on the left in the center two-way turn lane. Gu did not see the vehicle passing and continued to merge
left. The front left bumper of Gu's vehicle struck the right side of Unit#2.
1 contacted the driver of Unit#2, Ayana L. Nevers (DOB 09/24/1974), who told me the following:
Nevers was driving northbound on Oakesdale AVE SW. As the roadway continued into Monster RD
SW, Nevers attempted to pass Unit#1 while there were still two lanes before it merged into one. As
Nevers' vehicle passed Unit#1, Unit#1 merged left into Unit#2. Nevers stated the vehicle belonged
to a family member and she was not able to provide insurance.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both drivers. Unit#1 had minor crumple damage to the left front bumper and
fender, along with a broken headlight. Unit#2 had minor scrapes and dents on the right passenger
side door and box.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Gu and Nevers.
1, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 0851 hours on 09/19/2024 at Renton, WA.
PAGE 3 OF 4
REPORT NO.! EF16913 CASE# ' 24-9638 DATE AND TIME 09/13/24 17:03
OF COLLISION
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PAGE 4 OF 4
