HomeMy WebLinkAbout24-11999 ouCE OF ASHINGcN I� I �I) , II� I I I (III I�I I) SUPPLEMENTALREPORT NO. EF38797 1 8 27
COLLISION REPOFIT 1591971
SASE# 24-11999 2
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ STOLE F ❑ LOCAL AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2❑ TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK'
RESERVATION
z
3 DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E CITY IN # ❑
CowsloN 11 - 19 - 2024 2211 17 .� S H W H OF 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
e✓ --- ----� ❑
N 3RD ST MILEPOST
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET) BLOCK NO.
5❑ �.❑ FEET e S ❑ W e PARKAVEN
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
,/No D:8137585216 0 11
30
6� LAST NAME RADCLIFF FIRSTNAME RYAN MIDDLE T 1 2 31
INITIAL
STREET ❑, 13850 SE 180TH ST UNIT 110 CITY RENTON ST WA ZIP 98058 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
1/ I INTERLOCK YES[:]NO NTERLOCKYEs No�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 HELMET
2 CLASS 1 NATURE OF INJURIES z❑
3
10 $❑ P1 aTES� DV22030 sTArI WAurN# 2HKRW2H51 NH639791
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR. 5 1 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2022 MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 7 3 34
13 4 HOND CRV UT DAMAGE YES NO YES[:] NO✓
REGISTERED OWNER INFO RYANRADCL1FF 13850 SE 180TH ST UNIT 110 RENTON WA 98058 D:8137585216 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14� LIABILI INSURANCE INSURANCE CO STATE FARM 4108712-C15.47C 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LEGALLY
Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT VEHICLE ❑ CYCLE ❑ ❑
16 a OWNER ❑ YES 1/ NO D:2064309884
LAST NAME DONG FIRST NAME DUY MIDDLE P
INITIAL
17 STREET❑ NEW ADOREss❑' 4024 NE 6TH CT CITY RENTON ST WA ZIP 98056 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YEs t l NOF,/
19 LDI IVERI # STATE WA SEX M MMDDW 10 _ 09 _ 1996 39
20❑ ON DUTY STATUS I
AIRBAG 3 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# BOV5262 TArE 41
WA VIN# KMHD84LF3LU925463 1
42
22❑ PLATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2020 MAKE HYUN MODEL ELANTRA STYLE SD VEHICLE TOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO DUYDONG 4024NE 6TH CT RENTON WA 98056 D:2064309884 VEHICLE NO.2
SHADEDAMAGEDAREA
3 4
LIABILITY INSURANCE INSU&PORGY#E CO AMERICAN FAMILY 41025-50941-67 9TOP 5
IN EFFECT
VEHICLE ❑ CE J CITATION# CHARGE to BOTTOM
LEGALLY YES N J 6
25 OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# JAGENCY
26
KEV/N PETERSON 12808 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF38797
COLLISION REPORT III III III III III 111
1591972 CASE# 24-11999
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.
KEVIN PETERSON 12-20-24 11:32 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.EDWARDS 9070 1 1112312024 9:52:48 AM
BADGE OR ID# 1Y808 OR]# WA0171300 TIME POLICE DISPATCHED 10:18 PM TIME POLICE ARRIVED',10:21 PM
PART I PAGE IT]OF 4�
REPORT NO. EF38797 CASE# 24-11999 OF COLLISION
11/19/24 22:11
OF CbLLI510N
NARRATIVE
I was dispatched to a collision on 11/19/24 at 2218 hours at N 3rd St and Park Ave N, in city Renton,
King County WA.
Unit 1 DV22030 Driver: Ryan T. Radcliff (DOB 12/15/1977)
Unit 2 BOV5262 Driver: Duy P. Dong (DOB 10/09/1996)
Unit 2 was driving East on N 3rd street when he stopped at the intersection of N 3rd St and Park Ave
N due to the signal being out because of no power. He then went to go through the light heading East
in lane 2 when he the vehicle in the right lane stopped, he continued forward and was hit in the
intersection by Unit 1. Unit 1 was traveling in lane 2 heading North on Park Ave N when he was
approaching NE 3rd St and Park Ave N intersection, he did not realize it was a light due to the signal
being out and it so dark. Unit 1 drove through the light after slowing and then collided with Unit 2
hitting him.
Both drivers stated no injuries.
Both drivers were given a case# as reference.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 11/20/2024, 0006 hours at Renton,
WA
I was dispatched to a collision on 11/19/24 at 2218 hours at N 3rd St and Park Ave N, in city Renton,
King County WA.
I did a typo on my report Unit 1 DV22030 Driver: Ryan T. Radcliff (DOB 12/15/1977) should have
been Unit 2 in my report. Unit 2 BOV5262 Driver: Duy P. Dong (DOB 10/09/1996) is Unit 1 in this
incident. The narrative of what happen at the scene has not changed just the unit position. This is a
correction to my original report.
I certify (declare) under penalty of perjury under the laws of the State of Washington that the
foregoing is true and correct.
Electronically signed: Officer Kevin L. Peterson Date and Place: 12/20/2024, 2330 hours at Renton,
WA
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Surface Condition: COVERED IN TREE DEBREE
Motor Vehicle Unit 1
Traffic Control: LIGHT THAT WAS OUT WITH POWER
Motor Vehicle Unit 2
Traffic Control: TRAFFIC LIGHT THAT WAS OUT WITH POWER
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EF38797 CASE# ' 24-11999 DATE AND TIME 11/19/24 22:11
OF COLLISION
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PAGE 4 OF 4
