HomeMy WebLinkAbout25-905 iiTFiNII IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF67171oc� RA
COLLISION REPORT 1591971
❑ 0✓ FIRERES ED I
CASE# 25-905 2
INTERSTATE CITY STREET FIRESTOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eDCL s o v' 01 - 28 - 2025 0708 17 =.= S 8 W e OF IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
108TH AVE SE
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 MILES 1.1 FEET e S 8 W e SE 181ST ST
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2069407034 0 1 30
6 LAST NAME TANG FIRST NAME BRANDONLEE MIDDLE N 1 1 2 31
INITIAL
STREET ] 17848111THAVESE CITY; RENTON ST I WA ZIp; 980556539 2
NEW ADDRESS
7� +CDL IGN(TIUN REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs NO INTERLOCKYES NO YES F NO
S❑ DCIENSE# STATE WA SEXI M MMDDYY' 01 - 05 - 2009 1 2 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 12 EJECT 1 N USE ET CLASSY 1 [NATURE of INJURIES 2
LICENSE, CKG5425 STATE WA VIN# 19UUA66214AO07602 3
10 Fq I PI ATP tt
TRAILER STATE TRAILER STATE
11 4 0 PLATE# PLATE# FROM To
TRLR zRLR 1 1 3 33
12 4 0 VIN#' vIN#
FROM TO
LE
13 2 VEH.YEAR 2004 MAKE ACUR MODEL TL STYLE VEHICLE TO YED NOIyS46LIN diW9YMEYER YESr`-IVT ENp 5 1 34
DAMAGE IIII._IIII I_I
REGISTERED OWNER INFO SAILAR EAR 17848111TH AVE SE RENTON WA 98055 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 4
14 2 LIABILITY INSURANCE❑ NSURANCE CO
IN EFFECT &POLICY# 9TOP
V""' CHARGE I O BOTTOM 5 36
11
15
srnNowc yes❑NO❑ CITATION# 5A0151265,5A0151265 FAIL YIELD LEFT TURN MOTOR 7 e
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE CYCLE nWNFR D:2483784166
16�
LAST NAME CAD FIRST NAME MICHAEL MIDDLE' L
INITIAL
17 F1 STREET ❑❑ 37 20820 109TH LN SE CITY KENT 5T, WA ZIP 980311189
NEW ADDRESS
18❑ CDL IGNITION REtYUIRED IGNITION PRESENT MEDICAL TRANSPORTED ❑ 38
INTERLOCKYES NO INTERLOCK YES NO YES NO
19 DRIVE #
INJURY NATURE OF INJURIES 40
20❑ ON DUTY� STATUS AIRBAG 6 RESTR 4 EJECT 1 USE CLASS 1 ❑
21 LICENSEPLATE# CNJ9971 rare WA vIN# 1 FADP3F2XDL291298 41
22❑ PLATE# STATE PLATE# STATE 42
43
23 VfN RLR
UIN#. 'IN#
VEH.YEAR 201$ MAKE FORD MODEL FDC(/$ STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO VES NO
REGISTERED OWNER INFO MICHAEL BAD 20820109TH LN SE KENT WA 980311189 D:2483784166 VEHICLE NO.2
SHADE DAMAGED AREA
3 4
LIABILITY INSURANCE INSURANCE CO ST FARM C70 9777-B23.22
IN EFFECT &POLICY# 9TOP
VEHICLE
❑ ,J—I CITATION# CHARGE t080TTOM
EEGnEEY YES N`[
25 e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-345-159(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF67171
COLLISION REPORT III III III III III 111
1591972 CASE# 25-905
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET NJURY 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
blk/2 lane 2 nb gray Itl sb to eb
CC
Within the city limits of Renton/King/WA I responded to a 2 vehicle blocking at the intersection of
108th Ave SE at SE 181 st St.
I contacted the driver of unit 2 who told me he was northbound lane 2 at about 30-35 mph in a posted
40 zone when unit 1 turned left in front of him, across his path and contacted his vehicle. He did not
complain of injury and damages required a tow truck.
I contacted the driver of unit 1 ID'd by non picture WADL. He told me he was trying to turn left and
didnt make it in time crashing into unit 2. He was unable to provide proof of insurance. His father
arrived on scene and confirmed that vehicle did not have insurance. He did not complain of injury
and damages required a tow truck.
I cited unit 1 ref RCW 46.61.185 FTYROW-Left turn 2 vehicle crash and ref RCW 46.30.020 No valid
proof of insurance via complaint.
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 1/28/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 01-28-25 07:56 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 211912025 1:52:07 PM
BADGE OR ID# ; Y517 ORI#s WA0171300 TIME POLICE DISPATCHED 7:11 AM TIME POLICE ARRIVED i 7:14 AM
(PART B 3 Da-3mx—attar(t 1Mff) PAGE 2�OF F3
REPORT NO. E F67171 CASE# 25-905 DATE AND TIME 01/28/25 07:08
OF COLLISION
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