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HomeMy WebLinkAbout24-11139 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 5 27c COLLISION REP FIT 1591971 CASE 24-11139 z INTERSTATE ❑ CITY STREET FIRE ❑ RESULTED 1 STOLEN STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3 HIT&RUN CODING COUNTY RD PRIVATE WAY INVOLVED 2� 1 1 8 28 TOTAL#OF OBJECT TRIBAL UNITS 03 STRUCK' FENCE 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 1923 17 ❑.= S 8 IN e 1070 3 4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓ NILE AVE NE BLOCK NO. e✓ 2300 4a❑ MILEPOST DISTANCE OF(REFERENCE OR CROSS STREET) 5❑ 1000 FMILES N EET e S B OF NE 23RD ST 0 1 29 MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE UNIT 01 VEHICLE ❑ CYCLE El �/NO D:2068869929 2 2 30 6� LAST NAME LAM FIRSTNAME BRANDON MIDDLE N 1 1 2 31 INITIAL STREET ❑1 5210 NE 8TH PL CITY RENTON ST WA 21p 980594699 z NEW ADDRESS 7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3 iNTERLOCKYEs NO INTERLOCKYEs NO YEs NO 8❑ LRIIVER # ON DUTY❑ STATUS AIRBAG 6 RESTR 4 EJECT 1 HELMET U E 2 CLASS 1 NATURE OF INJURIES z❑ 3 10❑ P1 aT�S� BUH7416 sTArI WAVIN# JTEDS41AX82030323 TRAILER STATE TRAILER STATE 11 2 5 PLATE# PLATE# FR.. ro TRLR. YRLR.. 1 5 33 1 2 0 0 VIN#' VIN#i 9 34 13❑ VEH.YEAR 2008 MAKE TOYT MODEL HIGHLA STYLE VN VEHICLE TOWEDNOO pLSSBLIN TQ yEq.BLRs yOS❑ENO DAMAGE ILJI tSA1Vi�6 REGISTERED OWNER INFO 7AO HUANO 5211 NE 8TH PL RENTON WA 98059 VEHICLE NO. 1 ❑ SHADE IN DAMAGED AREA 35 14❑ LIABILI INSURANCE INSURANCE CO STATE FARM 5019662 D0447 4 IN EFFECT &POLICY# TOPVEHICLE CHARGE 36 LEGALLY YES❑NO❑ CITATION# <1�3 OTTOM 15❑ STANDING 6 MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE UNIT VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES NO ,/ D:2066439822 16❑ LAST NAME NGUYEN FIRST NAME HIEU MIDDLE I T INITIAL 17 STREET❑ NEW ADOREsS❑' 912 E SANDSTROM PL CITY KENT ST WA ZIP 980303700 4❑ 37 18❑ CDL IGNITION REQUIRED IGNITION PR—E-1SENT MEDICAL—T�RANSPORTED ❑ 38 INTERLOCK YEs❑NOR INTERLOCK YEs It I NOF YES t l NO❑ 19� D NEWSCENSE, STATE WA SEX M M .C... 10 �_ 09 _ 1992 39 HELMET INJURY NATURE OF INJURIES 40 20❑ ON DUTY STATUS' AIRBAG 9 RESTR 9 EJECT ''9 USE 9 0 CLASS ❑ LICENSE I ❑21❑ PLA E# CNR0141 TAre 41 WA YIN# STDYSKFC7RS143192 1 42 22❑ PLATE# STATE PLATE# STATE TRLR 23❑ UIN#. IN#. 43 RLR ' TOWED BY GOV HI 44 VEH YEAR 2024 MAKE 7'Oy7' MODEL SIENNA STYLE VN —TEHICLE TOWED✓ NOO BLIN BANKERS YES No�/ 24❑ REGISTERED OWNER INFO OWNED SY DRIVER VEHICLE N0.2 SHADE IN DAMAGEbAREA 2 3 Cd LIABILITY INSURANCE INSU&PORGY#E CO STATE FARM 4844177A2447B001 1 9TOP IN EFFECT 'E""LE ❑ N`L J ,J� CITATION# CHARGE LEG 25 i o BOTTOM ALLY YES $ ' OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY J 26 C.JACOBS 1953 WA0171300 PAGE 01 OF PART A 3000-345-159 OR 11/181 STATE OF POLICETRAFFICN CORRECTION REPORT NO. EF44881 COLLISION REPORT III III III III III 111 1591972 CASE# 24-11139 ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY) NAME(LAST FIRST,MIDDLE INITIAL) LE SOPHIE ADDRESS&PHONE# D O.B. ' 1212 REDMOND AVE NE RENTON WA 98056 SEXi F MMDovyvv 04 - 08 - 2009 PASSENGER Z WITNESS[:] UNIT# ( 1 SEA 3 AIRBAG 6 RESTR. 4 EJECT ? HELMET INJURY NATURE OF INJURIES USE CLASS 1 NAME (LAST,FIRST,MIDDLE INITIAL) LAM STANLEY N ADDRESS&PHONE# D O B 5210 NE 8TH PL PARENT RENTON WA 980594699 SEX' M MMDovvvv 07 _ 01 _ 1971 PASSENGER UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES [:]WITNESS POS. USE CLASS NAME (LAST FIR57 MIDDLE INITIAL) AppRESS&PHONE# SEX D.O.B.MMDD -❑ YYYY. 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. C.JACOBS 11-21-24 07:34 AM INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED APPROVED BY DATE C.JACOBS 1953 1 1211112024 3:37:48 PM BADGE OR ID# 1953 ORI# WA0171300 TIME POLICE DISPATCHED 7:24 PM TIME POLICE ARRIVED',7:30 PM PART I PAGE IT]OF 5� REPORT NO. EF44881 CASE# 24-11139 OF COLLISION 10/26/24 19:23 OF CbLLI510N NARRATIVE On 10-26-24 at about 2130 1 arrived in the 2300 block of Nile Ave NE for a 2 vehicle, into a fence collision. I contacted all involved parties in or near their vehicles/fence. All parties were identified via WADL. Driver 1, Brandon Lam told me; He was driving southbound when he came upon unit 2 stopped on the shoulder. He attempted to avoid unit 2 but struck it from the rear and then slid into the fence on the west side of the roadway. He nor his passenger were injured. He was aware that he has an intermediate license. Driver 2 told me; He had parked his vehicle on the shoulder to briefly run into the residence at 2351 Nile Ave NE. While he was inside the residence, unit 1 struck his vehicle. The vehicle was parked and unattended. I spoke to the property owner of the fence. He told me; He heard the collision, but he did not see it. I gave all involved parties an exchange of info. I issued Brandon Lam a citation via complaint for inattention and violation of intermediate license. Unit's 1 and 2 were towed by Bankers towing at the driver's request. Brandon is under the age of 18 so, I explained the collision to his father, Stanley Lam when he arrived at the scene. This incident occurred in the city of Renton, County of King. I declare under penalty of perjury under Washington state law that the foregoing is true and correct. C. Jacobs/1953 PAGE 3 OF 5 SUPPLEMENTAL REPORT NO. EF44881 r`I POLICE TRAFFIC 1 27 COLLISION REPORT CASE# 24-11139 1 COMMERCIAL MOTOR CARRIER INTERSTATE INTRASTATE G UNIT'# USL70r ICC# VEHICLE TYPE CARGO BODY TYPE 2 ❑ 1 28 CARRIER NAME 3 CARRIER L ADDRESS ` CITY ST' ZIP' 4 ❑ NAME # PLACARD: :❑ GI NAME IF NO NUMBER SOURCE AXLES + 4a ❑ ADDITIONAL UNITS MOTOR PEDAL- PROPERTY DAMAGE THRESHOLD MET PHONE 5 ❑ UNIT# 3 VEHICLE I_J CYCLE _) PEDESTRIAN � OWNER � YES� NO D:5622993234 MIDDLE.. 29 LAST NAME ST DENIS FIRST NAME KEVIN INITIAL J STREET 30 NEW AnnRFSP 5628 NE 23RD ST CITY RENTON ST WA ZIP 980594177 6 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TANSPORTED 1 31 INTERLOCK YEs No zERLOCK YES E]Na� YEs N L DRIVER'S STATE I SEX M M�DDYBYv 03 - 10 - 1960 LICENSE 7 F-ION DUTY STATUS AIRBAG RESTR. EJECT HELMET INJURY NATURE OF INJURIES F� USE CLASS 8 ❑ ' 1 32 LICENSE+ rar V1N.# PLATE# 9 TRAILER TRAILER PLATE# STATE PLATE# STATE 10 ❑ TRLR TRLR VIN.#. VIN.#. 11 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TOWS E T SABLIN TOWED BY anvi vEHIG E FROM TO DAMAGE YES NO YES NO REGISTERED OWNER INFO. m 33 12 SHADE IN DAMAGED AREA FROM TO IIABiLITY INSURANCE❑ INSURANCE CO IN EFFECT &POLICY# tGQ VEHICLE 34 13 ❑ LEGALLY YES[:] NO❑ CITATION# CHARGE STANDING S} 8 7 6 14 ❑ UNIT Tr Vd IRE O CYDCLE OWNER YES AGE NOHRESHOLD MET PHONE El 35 PEDESTRIAN 15 LAST NAME FIRST NAME MIDDLE': INITIAL36 STREET"[-] ❑ 16 NEW AnnREs.� CITY'. ST ZIP CDL IGNITION REdUiRED IGNITtGN PRESENT MEDICALTANSPORTED INTERLOCK YES No INTERLOCK YEs NO YEs NO El 17 37 LICENSE# STATE SEX MMDDDYBYY 18 ❑ ON DUTY� STATUS AIRBAG RESTR. ; EJECT HELMET INJURY NATURE of INJURIES 38 USE ICLASS 19 ❑ vIN# 39 LICENSE PLATE# rnr 20 ❑ TRAILER TRAILER ❑ 40 PLATE# STATE PLATE# STATE 21 ❑ TRLR TRLR 41 VIN# YIN#i 42 22 VEH.YEAR MAKE I MODEL STYLE I VEHICLE TO DUET SABLIN TOWED BY GOVT.VEHICLE DAMAGE YES NO YES NO 23 REGISTERED OWNER INFO_ SHADE IN DAMAGED AREA 43 3 4 71 LIABILITY INSURANCE INSURANCE CO ' VEHICLE EFFECT &POLICY# I 970P - 4 44 24 VEHICLE YES NO❑ CITATION# CHARGE iq 60TiOM E:l C=DLv STANDING 8 7 6 1 CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT. C.JACOBS 11-21-24 07:34 AM 25 INVESTIGATING OFFICER'S SIGNATURE OFFICER'S PHONE UNIT OR DIST DET DATED: PLACE SIGNED APPROVED BY DATE 26 OR ID# 1953 O#I',WA0171300 JACOBS 12111/202 PAGE�OF 3000-345-013(R 11118) REPORT NO. EF44881 CASE# ' 24-11139 DATE AND TIME 10/26/24 19:23 OF COLLISION 4 I t SJ 1 fr 4;. 9 3F k z � Z� O N,. a, Y t c t �x e t � Y� sv � o„ PAGE 5 OF 5