HomeMy WebLinkAbout25-1449 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF68541oc� RA
COLLISION REPORT 1591971
CASE# 25-1449 2
INTERSTATE CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE ❑ LOCAL A`OENC'Y 4100 3[--�
COUNTY RD INVOLVED CODING
PRIVATE WAY TOTAL 1
2❑ TRIBAL UNITS#OF 02 SOBJECT 7RUCK 1 8 28
RESERVATION 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
DATE OF'. N E IN coulsloN' 02 - 14 - 2025 1201 17 =.= S 8 W e OF M 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION Z NON INTERSECTION ❑
BLOCK NO.
MAPLE VALLEY HWY
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 �. FEET e S 8 W e SUNSET BLVD N
0 1 29
MOTtlR PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE' ❑ YES ✓NO O 6 30
6 LAST NAME PHONG FIRST NAME PHA MIDDLE C 1 2 31
INITIAL
STREET ❑ 5911 21 ST AVE S
NEW CITY, SEATTLE ST WA ZIP 981082987 2
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYES NO INTERLOCKYES NO YES NO
8 DCIENSE STATE WA SEX M MMDrYY 01 1 2 32
—NATUR
9� ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT, 1 HELMET INJURY 7 HEAD of INJURIES 2
USE ;CLASS HEAD OF
HAND
LICENSE', CFP5866 STATE WA VN# 4S3GTAM60P3703181 3
10 PI ATP ti'
TRAILER STATE TRAILER ,STATE
11 4 0 PLATE# PLATE# FROM TO
rRLR TRLR 3 7 33
12 4 0 VIN# VIN#
( FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN �tpyEN�I GOVT VEHICLE
13 2 2023 SUBA IMPREZ DAMAGE YES�NO� �"-"'"-�RS 3 7 34 YE NO
REGISTERED OWNER INFO MAI LOCK 3543168TH AVE NE BELLEVUE WA 98008 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
❑ INSURANCE CO 2 3 4
14 INLIABILITYEFFECT
INSURANCE TBA.
IN EFFECT &POLICY# i 4TOP 5
VEHICLE CHARGE 7 o BOTTOM 36
15
srnrroiNc yes❑NO❑ CITATION# 5AO151279,5AO151279 IMPROPER LANE USAGE,OP MOT 7 e
UNIT OZ MOTOR PEDAL ❑ PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
VEHICLE CYCLE. nWNFR YES NO
16�
LAST NAME CHEN FIRST NAME ZHONG MIDDLE N
INITIAL
17 F1 STREET ❑'❑ 10405 BECKER DR SW CITY LAKEWOOD ST, yyq ZIP 37
984994717
NEW AbDRESS
18� CDL IGNITION REfi]UIREO IGNTI{)N PRESENT MEDICAL TRANSPORTED 38
INTERLOCKYEs No INTERLOCK YES NO ves NO
19[ DRIVER'S STATE WA SEX M D.O.B. 09 12 1969 ❑ 39
LICENSE# MMODYY -
HELMET INJURY' NATURE OF INJURIES 40
20❑ ON DUTY❑ STATUS' AIRBAG 2 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSLATE E CFT8458 TATE WA VIN# 5TDYRKEC2PS147984 41
22❑ [TILER TRAILER
PLATE# STATE PATE# STATE ❑ 42
23 TRLR kRLR 43
UIN#. 'IN#.
TOWED BY GOV HI 44
VEH.YEAR 2023 MAKE TOYT MODEL SIENNA STYLE DAMIAGETOWED T BLIN BANKERS YES NI �/
24
REGISTERED OWNER INFO ZHONG CHEN 104058ECKER OR SW LAKEWOOD WA 984994717 VEHICLE NO.2
SHADE IN DAMAGE$AREA
2 3 �4
LIABILITY INSURANCE INSURANCE CO GEICI 6194 66 93 85
IN EFFECT &POLICY# t 9TOP 5
veeiae ❑ ,J—I CITATION# CHARGE to BOTTOM
LecnLLy YES N`[
25 s 7 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PART A PAGE 01 OF
3000-345-159(R 11/181
POLIICFETRAFFICN CORRECTION REPORT NO. EF68541
COLLISION REPORT III III III III III 111
1591972 CASE# 25-1449
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.
M.LEVERTON 02-18-25 09:51 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 212412025 12:26:10 PM
BADGE OR ID# Y517 ORI#' f WA0171300 TIME POLICE DISPATCHED! 12:02 PM TIME POLICE ARRIVED 12:04 PM
PART B 3 Do-3mx-,ao(Rtlras) PAGE 27 OF 47
REPORT NO.` EF68541 CASE# 25-1449 O COLLI COLLISION TIME
OF 02/14/25 12:01
COLLI
NARRATIVE
wht/2 lane 2 gray/2 rear 1 eb
CC
Within the city limits of Renton/King/Wa I responded to a 2 vehicle blocking crash at the intersection
of Maple Valley Hwy and Sunset Blvd N.
I contacted the driver of unit 2 who told me he was stopped and had been before being hit from
behind by unit 1. Unit 2 did not complain of injury and damages did not require a tow truck.
I contacted the driver of unit 1 who did not speak one word. He seemed slow and lethargic. He was
bleeding from his hand. I requested Renton Fire respond. He did provide me with a picture WADL,
and seemed to understand when I made the verbal request for his vehicle documents. He did not
provide insurance or a registration.
It looked like unit 1 was crowding two lanes of travel westbound and simply drove into the back of unit
2. There was no witnessed to provide any additional information.
cited unit 1 ref RCW 46.61.140 improper lane use and RCW 46.30.020 no insurance.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
M.Leverton/2517 City of Renton/King/Wa 2/18/2025
PAGE 3 OF 4
REPORT NO. EF68541 CASE# 25-1449 DATE AND TIME i 02/14/25 12:01
OF COLLISION
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