HomeMy WebLinkAbout24-12016 a POLICETRAFFic" II I f I) 11I1ll(111(111l If( f 11 REPORT NO. EF54764 5 6 27
COLLISION REP FIT 1591971
SASE 24-12016 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIr.I F ❑ LOCAL AOENC 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS OZ STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
COLLISION.. 11 - 1-- 2024 0935 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
BLOCK
NE SUNSET BLVD MILEPOST ST e✓ 1400
4a❑
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ ❑ FEET e S ❑ W e 0 6 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:4257705967 0 81
30
6� LAST NAME THAI FIRSTNAME K/ET MIDDLE D 1 1 2 31
INITIAL
STREET ❑✓ 666 SUNSET BLVD NE CITY RENTON ST WA 2jP, 98056 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO INTERLOCKYEs 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 1❑ PI ATFBit BJB4116 sTArI WA urN#' JF2SJAWC1JH517356
-- TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM To
TRLR. TRLR 3 7 33
12 3 5 VIN#j VIN#
:: FROM TO
❑ VEH.YEAR 2018 SUBA FOREST 5D MAKE MODEL STYLE VEHICLE TOWED fn TO VBLINJ TOWED BY I GOVT.VEHICLE J
13 9 34
4 DAMAGE YES NO YES[:] No
✓
REGISTERED OWNER INFO TONY THAI 10.111STSTSW LYNNWOOD WA 98036 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO AMFAMAX01184757 4
LI EFFECT I SUR N# TOPVEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# <1�3
OTTOM
15❑ STANDING 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER [:]EA.
YES 1/ NO D:5102061239
16 a
LAST NAME WU FIRST NAME MENGNI MIDDLE N
INITIAL
17 STREET❑ NEW ADDRESS❑' 4705 149TH AVE SE CITY BELLEVUE ST WA ZIP 980063127 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR-E-S1ENT MEDICAL-T�RANSPORTED � 38
INTERLOCKYES�NOR INTERLOCK YEs I I NOF YEs t l NO❑
19[—] DRIVER'S STATE WA SEX F D.C.B. 07 24 1988 39
LICENSE# MMDDYY
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U EET 2 NJAURSY 1 NATURE OF INJURIES 40
❑21❑ PLATE# CMT0655 TArE 41
WA VIN 1t 2T2BBMCAXRC049509 1
42
22❑ PILER LATE# STATE PLATE# STATE
23❑ UIN#. 43
TRLR RLR
'IN#.
VEH YEAR 2024 MAKE LEXS MODEL RX STYLE UT VEHICLE TOWED TO BLIN TOWEDBY GOV HI �44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO LEXUS BELLEVUE LEXUS CUSTOMER CO 101116TH AVE SE BELLEVUEWA98004 VEHICLE NO.2
SHADE IN DAMAGEbAREA
2 3 Cd
LIABILITY
INSURANCE INSU POLICY#E CO PENDING SELFIN 1 9TOP
'E""LE CITATION# CHARGE
LEG
25 i o BOTTOM
ALLY YES NEI
❑ s
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. EF54764
COLLISION REPORT III III III III III 111
1591972 CASE# 24-12016
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME MIDDLE INITIAL) LING ASHLEY
(LAST FIRST,
ADDRESS&PHONE#
4705 149TH AVE SE BELLEVUE WA 980063127 SEXi F MMDDYyry 02 - 04 - 2018
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT ' HELMET INJURY NATURE OF INJURIES
❑✓ ❑ 2 Sp SAY 9 2 12 1 USE 2 CLASS 11
NAME
(LAST,FIRST,MIDDLE INITIAL) LING NEO
ADDRESS&PHONE# D O B
BELLEVUE SEX M M-D Y, 08 _ 03 _ 2016
SEAT HELMET INJURY NATURE OF INJURIES
PASSENGER Z WITNESS❑ UNIT# 2 PGS 7 AIRBAG 1 RESTR. 10 EJECT 1 USE 2 CLASS 1
NAME
(LAST FIRST,MIDDLE INITIAL) WU RENGANG
AppREss&PHONE# BELLEVUE M M O6 U7 _ 1983
SEX.
MDDYYYY
PASSENGER WITNESS UNIT# ! 2 SEAT 3 AIRBAG 2 RESTR. 4 EJECT 1 HELMET 2 INJURY 1 NATURE OF INJURIES
❑ POS. USE GLASS --- ----�
NARRATIVE'
On 11-20-24 at about 0945 1 arrived in the 1400 block of NE Sunset Blvd for a 2-vehicle collision.
When I arrived, both vehicles were still in lane 2 of the westbound lanes, with unit 1 behind unit 2. 1
contacted both drivers in/or near their vehicles. After collecting their information, I had them pull off
the roadway to a nearby service area used by construction companies to safely complete the
exchange of information/report. Both drivers were identified via WADL.
Driver 2 told me;
they were stopped in queued traffic waiting for the light to change when unit 1 struck them from the
rear.
There were no reported injuries at this time.
The vehicle was a loaner from the dealership.
Driver 1, Kiet Thai told me;
He had just changed lanes from lane 1 to lane 2 and was unable to stop before colliding with unit 2.
He was not injured.
Based on all accounts of the incident, driver 1 is the proximate cause of the collision. I issued Kiet a
verbal warning, provided both drivers an exchange of information and released them from 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
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
C.JACOBS 11-28-24 02:13 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 1 11812025 2:27.18 PM
BADGE OR ID# 1953 ORI#' WA0171300 TIME POLICE DISPATCHED; 9:37 AM TIME POLICE ARRIVED;9:45 AM
PART I PAGE IT]OF 3�
REPORT NO. EF54764 CASE# ' 24-12016 DATE AND TIME 11/20/24 09:35
OF COLLISION
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