Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
HomeMy WebLinkAbout24-10935 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 1 27c
COLLISION REP FIT 1591971
CASE 24-10935 z
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 N E IN CITY#
COLLISION' 10 - 1-- 2024 1926 17 ❑.❑ S 8 W e IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
MAPLE VALLEY HWY BLOCK NO. e✓ 1820 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV e PARKING LOT
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
�/No D:4254663030 0 4 30
6❑ LAST NAME SHIM FIRSTNAME SO MIDDLE E 1 1 2 31
INITIAL
STREET ❑✓ 2007 REDMOND AVE SE CITY RENTON ST WA Zjp, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION : PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YEs No�/
8❑ LDRIVER # STATE WA SEX'F MMDDYY 07 - 15 - 2002 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USE 2 CLASS 1 NATURE OF INJURIES z❑
3
LICENSE CGS8169 sTArI WAurN# 4S3GTAV69P3718874
10❑ PI ATE 14
TRAILER STATE TRAILER STATE
11 0 0 PLATE# PLATE# ROM ro
TRLR. TRLR 3 7 33
12 0 0 VIN#' VIN#
:: FROM TO
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 7 34
13 3 2023 SUBA IMPREZ DAMAGE YES NO YES[:] No✓
REGISTERED OWNER INFO HYON KIM 450 CENTRAL WAY UNIT 1505A KIRKLAND WA 98033 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO STATE FARM 5430177A2147A 3 4
IN EFFECT &POLICY# 9TOP
VEHICLe 5 36
LEGALLY
Yes❑NO❑ CITATION# CHARGE 10 BOTTOM
15❑ STANDING
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑ : OWNER ❑ YES NO ,/ D:2063994876
16 a
LAST NAME LAU FIRST NAME MING MIDDLE I C
INITIAL
17 STREET I13TH AVE SE CITY KENT ST WA ZIP 980305059 4❑ 37
NEW ADOREs�' 25029 1
18� CDL IGNITION REQUIRED IGNITION PR-E-1SENT MEDICAL-T�RANSPORTED 38
INTERLOCKYES�NO� INTERLOCK YEs It I NOF YES
t l NOF,/
19 DRIVER #
❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑ILICENSE 21❑ PLA E# BA63472 TArE WA VIN# 41
2HKRM4H54GH601699 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2016 MAKE HOND MODEL CRV STYLE 5D VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
24❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO MING LAU 25029113TH AVE SE KENT WA 980305059 D:2063994876 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY
INSURANCE INSU&PORGY#E CO STATE FARM 0445061EI8471IN STOP 5
VEwCLE ❑ ,J� CITATION# CHARGE
25 io BOTTOM
LEGALLY YES N J
' a
=TURNER
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26 12650 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF27829
COLLISION REPORT III III III III III 111
1591972 CASE# 24-10935
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST FIRST,MIDDLE INITIAL)_
ADDRESS&PHONE#
SEX D.O.B. - -
MMDDYYYY.
PASSENGER❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
PM USE CLASS
NAME
'(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D D B
SEX MMDDYYYY
PASSENGER ❑WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES
POS. USE CLASS
NAME
(LAST FIR57 MIDDLE INITIAL)
AppRESS R 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.
JASON TURNER 10-22-24 03:38 PM
NVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
J.CHRISTIANSEN 10437 1 1012312024 7:57:23 PM
BADGE OR ID# 12650 ORI# WA0171300 TIME POLICE DISPATCHED 7:28 Pry TIME POLICE ARRIVED',7:35 PM
PART I PAGE IT]OF 4�
REPORT NO. EF27829 CASE# 24-10935 OF COLLISION
10/20/24 19:26
OF CbLLI510N
NARRATIVE
Unit 1 was driving westbound on Maple Valley HWY in the #2 lane approaching a redlight at the 1800
block of Maple Valley Hwy. Unit 1 stated that they were pretty certain they had a green light and
proceeded through the intersection. While proceeding through the intersection Unit 2 was making a
left turn to proceed northbound into the parking lot of 1800 Maple Valley HWY. Unit 1 stated that Unit
2 collided with them striking the driver's side door panel of the vehicle. Unit 1 reported no injuries and
the vehicle was able to drive under it's own power. The vehicle had significant damage to the driver's
side door.
Unit 2 stated that they were attempting to make left turn to proceed northbound at the 1800 block of
Maple Valley HWY. Unit 2 stated that they had a solid green arrow while oncoming traffic had a solid
red light. Unit 2 proceeded to make their turn when Unit 1 ran through the red light proceeding
westbound on Maple Valley HWY.Unit 1 drove directly into the path of Unit 2's turn and caused the
vehicle's to collide. Unit 2 had minor damage to the front end of the vehicle and no injuries were
reported. Unit 2 was able to drive under it's own power.
Both vehicles had dash cameras but I was unable to review footage from either vehicle. Unit 1 stated
that the dash camera came unplugged during the collision. Unit 2 stated that they may have footage
but had no way of reviewing it a the time.
There is no further information at this time.
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct. Electronically signed by J. Turner 12650 on 10/22/2024 at 1537 hours.
PAGE 3 OF 4
REPORT NO. EF27829 CASE# ' 24-10935 DATE AND TIME 10/20/24 19:26
OF COLLISION
%a
ti.
S
t
PAGE 4 OF 4