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HomeMy WebLinkAbout24-10484 )STATE TFC 0 6 27I OCERAF EF26186 COLLISION REPRT 1591971 CASE# 24-10484 2 INTERSTATE CITY STREET FIRE ❑RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`NG 4250 3 COUNTY RD NVOLVED CODING PRIVATE WAY 2❑ TOTAL 1 TRIBAL 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 GOUISION' 10 - 08 - 2024 0751 17 =.�� S W OF 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION �✓ NON INTERSECTION ❑ 116TH AVE SE BLOCK NO. e 1800 .� 4a❑ MILE POST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 �. FEET S 8 W e SE 180TH ST 0 2 29 MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO O 4 30 6 LAST NAME UNKNOWN FIRST NAME UNKNOWN MIDDLE 1 1 2 31 INITIAL STREET ❑ UNKNOWN CITY RENTON WA NEW ADDRESS ST ZIP 98055 2 7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3 INTERLOCKYES ✓No INTERLOCKYEs NO✓ YEs No,/ 8 LICIVERS ENSE# STATE SEX F MMDDYY' -=-MOS. 11 2 32 9 ON DUTY STATUS AIRBAG 9 RESTR 9 EJECT 9 HELM USEET 9 CLASS 0 NATURE OF INJURIES 2 10 LI ENSE'' 97ONQR STATE OR VIN# 1G1ZT648X5F237190 3 11[-j— TRAILER STATE TRAILER ,STATE FROM TO 11 0 0 PLATE# PLATE# 1 5 TRLR TRLR 33 12 0 0 VIN# VIN# ( FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BUN TOWED BY GOVT VEHICLE 13 2 2005 CHEV MALIBU 4D DAMAGE vesNo ✓ Yes❑ No✓ 1 3 34 REGISTERED OWNER INFO JOSEPH LEE 2730 SE 92ND A VE APT 205 PORTLAND OR 97266 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 LIABILITY INSURANCE❑ INSURANCE CO 14 ✓ AMICA PROP 8 CAS INS CO 9411362311 IN EFFECT &POLICY# 9TOP vEnicLE t S 36 LEGALLY YES[:]NO[:] CITATION# CHARGE 7 o BOTTOM 15❑ sTANowG s 7 e III MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE CYCLE nWNFR YES✓ NO D:2067781768 16� LAST NAME DANG FIRST NAME PHUOC MIDDLE H INITIAL STREET ❑ 17� '❑ 11804 SE 176TH CT CITY I RENTON ST, yyq ZIP 98058 g 37 NEW AbbRESS 18❑ CDL IGNITION REQUIRED3 (GNTION PRESENTMEDICALTRANSPORTED: 38 INTERLOCKYEs No✓ NTERLOCI YES 424 vEs No✓ 19 DRIVER'S STATE WA SEX M D.O.B. 10 08 1970 39 LICENSE# MD.02. — 20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET 2 INJURY NATURE OF INJURIES 7 40 USE CLASS COMPLAINT OF NECK PAIN 21 LICENSLATE E BZD5397 rare WA vIN# 4T1BB46K17U020923 41 22❑ PLATE# STATE[TILER I PATE# STATE ❑ 42 23 TRLR kRLR 43 UIN#. 'IN#. VEH.YEAR 2007 MAKE TOYT MODEL CgNJRy STYLE 4p VEHICLE TOWED TO BLIN TOWED BY GOV HI 44 24 DAMAGE YES NO✓ YES NO✓ REGISTERED OWNER INFO DUYEN NGUYEN 11804 SE 176TH CT RENTONWA 98058 VEHICLE NO.2 SHADE IN DAMAGED AREA 2 3 4 LIABILITY INSURANCE INSURANCE CO STATE FARM 5035698DZ947A IN EFFECT &POLICY# tUR L,IAIL ❑ CL JCITATION# CHARGELEGALLY YES N25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 ROBIN SMITH 12986 WA0171300 PAGE 01 OF PART A 3000-345-159(R 11/18) POLIICFETRAFFICN CORRECTION REPORT NO. EF26186 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10484 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) 'NAME (LAST,FIRST MIDDLE INTTIAL) ADDRESS&PHONE# SEX' D.O.B. — [----------� MMDDYYYY PASSENGER F-1 WITNESS Ej UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES--� POS. USE CLASS 'NAME (LAST FIRS,MIDDLE INITIAL) ADDRESS&PHONE# SEX' D.O.B. — L----------� MMDDYYYY PASSENGER DWITNESSD UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES POS. : USE CLASS ----� '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. — L----------� MMDDYYYY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES ❑ Q POS. USE CLASS �____ ----j 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. ROBIN SMITH 10-08-24 10:20 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY E DAT P.KORDEL 9676 1011912024 3:03:43 PM BADGE OR ID# 12986 ORI# ( WA0171300 TIME POLICE DISPATCHED'; 8:12 AM TIME POLICE ARRIVED 8:23 AM PART B 3oDo-345-,ao(Rtrras) PAGE 27 OF 47 REPORT NO. EF26186 CASE# 24-10484 OF COLLISIONS 10/08/24 07:51 OI;COLLISICiN NARRATIVE Renton Case #24-10484 On 10/08/2024 at approximately 0812 hours, I was dispatched to the intersection of 116th Ave Se and Se 180th St, in the City of Renton, King County, Washington, for a report of a non-injury, blocking accident. Upon arrival I identified Unit 2 as a gold 2007 Toyota Camry bearing WA license plate #BZD5397. Unit 2 sustained damage to the front driver side. When attempting to move the vehicle off the roadway the tires would not turn with the steering wheel indicating that the front ankle was broken. I requested a tow truck thru dispatch. I contacted the driver of Unit 2 who had family members on scene to translate Vietnamese. The driver is Phuoc Huu Dang DOB: 10-08-1970 (verified by WADL). Phuoc said he was traveling southbound on 116th Ave Se waiting to turn eastbound onto SE 180th St. As he began his turn, Unit 1 passed him on his driver side colliding with him. The driver of unit 1 stopped and talked to Phuoc. They obtained Phuoc's information but did not provide their own before leaving the scene heading southbound on 116th Ave Se. Phuoc provided proof of insurance thru State Farm (Policy#5035698DZ947A). Phuoc said that his neck was sore, but he declined to be seen by medical. Phuoc's family had video and photos of Unit 1. Unit 1 is a blue 2005 Chevy Malibu bearing OR license plate #970NQR. Phuoc described the driver as a black female adult in her 30's, approximately 57' with shoulder length black hair. The video showed the female wearing a pink and white horizontal stripped sweater with a black jacket over the top, black jeans, and black boots. The identify of the driver of Unit 1 is unknown. provided Phuoc's family member with an axon link to upload the photo and video they have of Unit 1. Banker tow arrived to tow the vehicle. I provided Phuoc with my business card with the case number written on it. I answered Phuoc's questions and once the vehicle was towed I cleared the scene. This ends my report. I certify (declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct. Electronically signed by R. Smith #12986 on 10/08/2023 at 1013 hours, in the City of Renton, WA. PAGE 3 OF 4 REPORT NO. EF26186 CASE# 24-10484 DATE AND TIME i 10/08/24 07:51 OF COLLISION y 9Y 4a�, rJ } r ?' ? 1+, i e' 3 3 ? PAGE 4 OF 4