HomeMy WebLinkAbout24-11449 a ITFFi "POLCERA II IfI) 1 IlfII ('II (Illf If( fI I . 6 27c
COLLISION REP FIT 1591971
CASE 24-11449 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 TOTAL#OF OBJECT 2$
TRIBAL UNITS 02 STRUCK' META!SIGN POST
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
cawsloN 11 - 04 - 2024 1610 17 ❑.❑ S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 2ND ST BLOCK NO. e✓ 3555
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 250 00 FMILES EET e S ❑ W e MONROE AVE NE
0 1 29
UNIT 01 VEHtOCLE PEDAL-
❑ YESA,GEE NHORESHOLD MET PHONE 30
6� LAST NAME NGUYEN FIRSTNAME JESSICA MIDDLE M 1 2 31
INITIAL
STREET ❑, 5710 S NORFOLK ST CITY SEATTLE ST WA 2jp, 98118 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I iNTERLOCKYEs NO NTERLOCKYEs NO Z/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET USE 2 CLASS 1 NATURE OF INJURIES 2❑
3
10� P1 aT�S� 43853D sTAT� WAurN# 1 FDXE45SX6DA35949
TRAILER STATE TRAILER STATE
11 2 5 PLATE# PLATE# Rom ro
TRLR. TRLR 3 7 33
12❑ VIN#' VIN#.
2006 FORD ECONO gU OIIF FROM 34
❑ VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED ILJ TO BLIN TOWED BY GOVT.VEHICLE
13 2 DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO RENTON C/TYOF 1055 S GRADY WAY RENTON WA 98057 D:4254307500 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14❑ LIABILITY INSURANCE INSURANCECO CITY OF RENTON SELF INSURED 4
IN EFFECT &POLICY# 9TOP
VEHICLe CHARGE 5 36
15❑ LEGALLY STANDING YES❑NO❑ CITATION# 1 o BOTTOM
8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY 2/ DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:4254307500
16❑
LAST NAME RENTON FIRST NAME CITY OF MIDDLE
INITIAL
17❑ NEW STREETREs7 1055 S GRADY WAY CITY RENTON ST WA ZIP 98057 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 LLIICENS # STATE SEX U MMODYY —�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ TATE LICENSE vIN# 41
1
PLATE#
42
22❑ PR TRAILER LATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
VIN#. IN#.
VEH YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE❑ INSURANCE
#E CO
IN EFFECT &PO I 9TOP 5
vE""LE ❑ ,J� CITATION# CHARGE i o BOTTOM
LEGALLY YES N J
25 s e
=ON
NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26 12421 WA0171300
PAGE 01 OF
PART A
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF33166
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11449
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.
D.NELSON 11-05-24 02:53 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
P.SUMMERS 8887 111712024 6:50:45 PM
BADGE OR ID# ! 12421 ORI#' WA0171300 TIME POLICE DISPATCHED 4:92 Pry TIME POLICE ARRIVED]4:13 PM
PART I PAGE IT]OF 4�
REPORT NO. EF33166 CASE# 24-11449 OF COLLISION
11/04/24 16:10
OF CbLLI510N
NARRATIVE
24-11449 COLL
On 11/4/2024 1 was working as a uniformed patrol officer and driving a marked patrol vehicle for the
City of Renton. I was dispatched to a report of a collision without injury at the entrance to the Renton
City Shops located at 3555 NE 2nd St Renton/King/WA. Tom Puthoff, a supervisor for the facility, was
calling to report that an employee had struck a gate pole with a city owned vehicle.
I located the white 2006 Ford Econoline bus WA/43853D, parked near the front of the shops. The bus
had damage to the front passenger side quarter panel, passenger side rearview mirror, and
passenger entry door. The gate pole was partially knocked over.
I spoke with the driver, identified by her WADL as Jessica M Nguyen DOB: 12/1/1999, she said she
had pulled up to the gate as a large vehicle was exiting. She said that she moved to the right to try to
make more room and struck the gate pole as she entered the shops area. She said she was not
injured.
No tow was required.
I took photographs of the damage and uploaded them to Axon Evidence.
Nothing further.
I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true
and correct.
D. Nelson #191 11/4/2024 Renton WA
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Traffic Control: METAL GATE
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EF33166 CASE# ' 24-11449 DATE AND TIME 11/04/24 16:10
OF COLLISION
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PAGE 4 OF 4
