HomeMy WebLinkAbout24-12810 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF49251OLCERA
COLLISION REPORT 1591971
CASE# 24-12810 2
INTERSTATE CITY STREET FIRE I
RESULTED STOLENSTATE 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#
DATE OF N E
cDLLISION' 12 - 14 - 2024 1616 17 =.= S 8 W e OF M 1070 a
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO. e .�
4a
NE 4TH ST MILE POST
❑
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1. FEET e S 8 W e HOQUTAM AVE NE
0 4 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:4255476040 0 1 30
6❑ LAST NAME DIEP FIRST NAME XUAN MIDDLE H 1 2 31
INITIAL
STREET ] 5109 NE 8TH PL CITY; RENTON ST WA ZIP 980594697 2
NEW ADDRESS
7 CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCK YES NO✓ INTERLOCK VES Na✓ YES F NO✓
8 DCIENSE# STATE WA SEXI M MMDDYY' 01 - 05 - 2004 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 2 RE
STR 4 EJECT 1 HELMET
2 CLASSY 1 [NATURE of INJURIES 2
10 1� LI ENSE' A WC3633 STATE WA VIN# 5T0YK3DC9DS281110 3
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# ROM To
TRLR TRLR 7 1 1 33
12 3 5 VIN# vIN#
FROM TO
13 3 VEH.YEAR2014 MAKE ToYT MODEL SIENNA STYLE VEHICLE TOYED NO�iS46LIN T�VyED.6LRS CLE $ 7 34
DAMAGE IIII._IIII HHttVVii((tt
REGISTERED OWNER INFO pHOLOT DIEP 5109 NE 8TH PL RENTON WA 98059 VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
3 LIABILITY INSURANCE INSURANCE CO 14 STATE FARM 472t272-Af6-47A
IN EFFECT &POLICY#V""' CHARGE 36
LEDgLLY YES❑NO❑ CITATION# <14,
15 STANDING
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE CYCLE nWNFR D:4257382048
16�
LAST NAME HOLMAN FIRST NAME TIMOTHY MIDDLE D
INITIAL
STREET ❑
17� ❑ 14410 158TH PL SE CITY RENTON ST, WA ZIP 980597432 4 37
NEW ADDRESS
1$❑ IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
CDL INTERLOCKYES NO✓ INTERLOCK YES No✓ YES NO✓
19 DRIVER'S STATE WA SEX M D.o.a. T08 29 1972 39
LICENSE# MMDDYY -
20❑ ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 R USEET 2 CLASSY 1 NATURE OF INJURIES 40
21 LICENSE I
PLATE# D076776 TATE I WA VIN# 1 FT7W2B62NEE20850 41
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2022 MAKE FORD MODEL F250 STYLE pi( VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO✓ VES NO✓
REGISTERED OWNER INFO LLC CSA SERVICE SOLUTIONS 14410158TH PL SE RENTON WA 98059 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCE CO ACORD 16107762
IN EFFECT &POLICY# t
VEHICLE ❑ ,.I—I CITATION11 CHARGE UQ
LEGALLY YES N
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
E.CHANG 10065 WA0171300
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF49251
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12810
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 INJURY 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
On 12-14-2024 at about 1619 hours, I was sent to a collision reported at the intersection of NE 4th St
and Hoquiam Ave NE, in the City of Renton, King County, Washington.
Upon arrival 1 spoke with both drivers and they had the same account of the collision.
Unit 1 was stopped at the intersection of NE 4th St facing eastbound waiting to make a northbound
turn onto Hoquiam Ave NE. Driver said he had a green light and made a left turn and struck unit 2.
Unit 2 was headed westbound on NE 4th St going through the intersection in lane 2 and was struck
by unit 1. Driver said he had a green light.
The left turn made by unit 1 was a contributing factor in the collision. Driver of unit 1 did not yield
right of way to unit 2.
Unit 1 was towed from the scene.
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
E.CHANG 12-15-24 10:21 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
P.KORDEL 9676 i 1212312024 9:00:08 AM
BADGE OR ID# j 10065 ORI# WA0171300 TIME POLICE DISPATCHED 1 4:19 Pry] TIME POLICE ARRIVED i 4:29 PM
PAST B a Da-3mx-attar(t 1Mff) PAGE 2�OF F3
REPORT NO. EF49251 CASE# 24-12810 DATE AND TIME 12/14/24 16:16
OF COLLISION
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