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HomeMy WebLinkAbout24-10641 ("7— STATETcN 27CERAFFi O EF36887 COLLISION REPCF 1591971 ❑ FIRE CASE# : 24-10641 2 o 5 INTERSTATE CITY STREET ✓ RESULTED 1 STATE ROUTE OTHER STOLEN VEHICLE ❑ LOCAL AGENCY] 4200 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2 JECT TRIBAL UN TS#OF 02 STRUCK 1 8 2$ RESERVATION: 2 3 M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY# coi slon 10 - 11 - 2024 1723 17 �.= S No W e OFE IN 8 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NONINTERSECTION ❑✓ RAINIER AVE S BLOCK NO. 8✓ 700 .� 4a❑ MILEPOST ❑ DISTANCE OF(REFERENCE OR CROSS STREET) 5 100 00 MILES FEET e✓ S e W 8 HARDIE AVE SW 2 0 29 MOTOR ✓ PEDAL- DAM ETHRESHOLD MET PHONE UNIT 01 VEHICLE CYCLE' YES No ,/ D:2064278973 0 11 30 6 LAST NAME PHASAVATH FIRST NAME KHAMPOUK MIDDLE 1 2 31 INITIAL STREET [:] 9265 WATERS AVE S#2010 CITY SEATTLE WA NEW ADDRESS ST ZIP 9811$ 2 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 1NTERLOCKYEs No,/ INTERLOCKYEs No✓ YEs NO,/ 8❑ 1 LDRIV SE� STATE I WA SEX M M LO S 12 - 31 - 1968 1 1 2 32 9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE T INJCLA RSY 1 NATURE OF INJURIES 2 �ci ATF#' C27200G srnr� WA uIN# .1T4RN50R7H5109249 3 10 9❑ 11 3 5 PLARA TE# STATE PLATE# STATE ROM To TRLR. TRLR. 1 5 33 12 3 5 VIN# VIN# FROM TO VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT. NO 13 4❑ 1987 TOYT PICKUP PK OHMAGE YES NO ✓ YEs NO✓ 1 5 34 REGISTERED OWNER INFO KHAMPOUK PHASAVA TH 9265 WATERS AVE S SEATTLEWA98118 D:2064278973 35 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 14 LIABILITY INSURANCE❑ NSURANCE CO IN EFFECT &POLICY# 9 vEwcLE CHARGE I 1080TTOM 5 ❑ 36 TAN IN YES No ciranoN# 4AO740793 OP MOT VEH W/OUT INSURANCE, 15❑ sTAno nc s 7 e 1 MOTOR ✓ PEDAL PEDESTRIAN PROPERTY �'"''� DAM THR OLD MET PHONE UNIT 02 VEHICLE Z CYCLE OWNFR u YES✓ NO D:2069662550 16F1 LAST NAME ABRENICA FIRST NAME CESIL-KA'LEO MIDDLE A INITIAL 17❑ STREET Ell 4400 NE SUNSET BLVD#12 CITY RENTON I ST' WA ZIP 1 98059 4❑ 37 NEW ADDRESS 18F] IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED' 38 CDL :ERLOCKYEs N0,/ INTERLOCK YESs rya,/ YEs R No✓ DRIVER'S; STATE WA SEX D M .O.B. 12 11 2007 39 19❑ LICENSE# MMDDYY [-------� 20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H U SE CLASSINJURE NATURE OF INJURIES 40 ❑21❑ LICENSE CMT3046 rArE W 41 A vIN 1HGCP26338A017369 1 PLATE# 42 22❑ PLATE# STAILER TATE PLATE#TRAILER STATE 23 43 TRLR RLft UtN#. IN# VEH.YEAR 200$ MAKE HOND MODEL ACCORD STYLE SD VEHICLE TOWED TO BLIN TOWED BY GO HI 44 24 DAMAGE YES NO,/ YES NO✓ REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO.2 SHADEDAMAGEDAREA 3 4 LIABILITY INSURANCE INSURANCE CO STATEPARM 521 2312-B05-47B IN EFFECT &POLICY# STOP -- 5 vEHICI.E YES❑ N.1—I CITATION# CHARGE 1060TTOM LEGALLY J 25 e 7.FFIS NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY 26 TAGNE 12575 WA0171300 PARTA 3000-345-159 FIR11/1M PAGE 01 OF STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF36887 COLLISION REPORT III III III III III 111 1591972 CASE# 24-10641 ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY) '.NAME (LAST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE SEXi D.O.B. - MMDDYYYY PASSENGER WITNESS ;UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES POS. ' USE CLASS 1 ----� :NAME (LAST FIRST MIDDLE INITIAL) ADDRESS&PHONE# SEX D.O.B. - MMDDYYYY PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES POS. USE CLASS ----� :NAME (LOST,FIRST,MIDDLE INITIAL) ADDRESS&PHONE# SEX MMDDYY D.O.B. YY PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES ❑ ❑ POS. I 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 10-12-24 03:20 PM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED APPROVED BY DATE G.BARFIELD 6476 1 1111812024 3:25:33 PM BADGE OR ID# 12575 ORI# WA0171300 TIME POLICE DISPATCHED 1 5:24 PM TIME POLICE ARRIVED i 5:28 PM PART B 3000-345.160(R1Vt8) PAGE 0 OF 47 E AND REPORT NO.i EF36887 CASE# 24-10641 OF COLLISIONS ' 10/11/24 17:23 OF ca�.�isiaN NARRATIVE 24-10641 On 10/11/2024 at approximately 1723 hours, 1, Officer Lantagne, responded to a non-blocking, non- injury collision which occurred in the 700 block of Rainier AVE S, 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 and body worn vehicle. I arrived on scene and observed Unit#1, a 1987 Toyota Pickup with license plates C2720OG issued out of Washington State, and Unit#2, a 2008 Honda Accord with license plates CMT3046 issued out of Washington State, parked in the Walmart parking lot. I was advised there were no injuries. I contacted the driver of Unit #1, Khampouk Phasavath (DOB 12/31/1968), who told me the following: Phasavath was driving southbound in a center lane of Rainier AVE S in the 700 block. Phasavath merged right into the curb lane to turn right into Walmart and the right rear of his vehicle struck the front left bumper of Unit#2. Phasavath did not have insurance coverage. contacted the driver of Unit#2, Cesil-Ka'leo A. Abrenica (DOB 12/11/2007), who told me the following: Abrenica was driving southbound in the curb lane of Rainier AVE S in the 700 block. Before Abrenica could make a right turn into the Walmart parking lot, Unit#1 merged into his lane and the right rear bumper of Unit#1 struck the left front side of Abrenica's vehicle. I observed the damage to the vehicles and other physical evidence was consistent with the statements made by both drivers. Unit#1 had minor damage to the right rear box and bumper which was scraped and dented. Unit#2 had the front bumper and grill torn from the vehicle. The collision diagram is an accurate illustration of the events leading up to the collision. I provided an exchange of information to Phasavath and Abrenica. I issued Phasavath an infraction for the unsafe lane change and for operating a motor vehicle without insurance. I, 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 1837 hours on 10/11/2024 at Renton, WA. PAGE 3 OF 4 REPORT NO. EF36887 CASE# 24-10641 DATE AND TIME 10/11/2417:23 OF COLLISION F Y � v, I r r e � n 2 u f a r �' l ➢ t�j'�h''tF , PAGE 4 OF 4