HomeMy WebLinkAbout25-1002 TFG " II I III I III I I III ' I III) III II I 27aucERA c REPORT NO. EF61706
. COLLISION REPORT 1591971
SASE# 25-1002 2
INTERSTATE CITY STREET FIRE ❑
RESULTED
1 2 STOLEN
STATE ROUTE ❑ OTHER ❑ VEHICLE L: OCALAGENCI 4200 3
HIT&RUN CODING
2 3
COUNTY RD � PRIVATE WAY � INVOLVED TOTAL#OF OBJECT 1 1 8 28
TRIBAL 1
RESERVATION UNITS 02 STRUCK
2�
3 1 M M D D Y Y Y Y TIME(24001 COUNTY# MILES CITY#
coLC sO{7FN' 01 - 31 - 2025 1107 17 =.= S 8 E e I F e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 3RD ST BLOCK NO. 8✓ 2000 .�
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 160 00 FMILES N EET e S 8 E e BRONSON WAY NE
0 1 29
MOTOR PEDAL- DAM ETHRESHOLD MET PHONE
UNIT 01 VEHICLE CYCLE' vEs No �/ D:4255021063 OF
1 30
g LAST NAME EVANS-WALLS FIRST NAME MORGAN MIDDLE A 1 1 31
INITIAL
STREET El 14405 160TH AVE SE CITY RENTON WA
NEW ADDRESS ST ZIP 98059 2
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
INTERLOCKYEs No T/ I INTERLOCKT� YES I NO,/
$ LICENSE# STATE WA SEX F MDnnDow 10 - 03 - 1994 1 2 32
9 ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 HELM ET 2 INJ SS 1 NATURE OF INJURIES 2
�
CLA
LICENSE CHP9615 STAT' WA WIN# JT3HN86RXW0159629 3
10 9 P1 ATE�t
STATE TR
AILER
RAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR TTRLRr 7 3 33
12 3 5 VIN# VIN#
FROM TO
VEH.YEAR 1998 MAKE TOYT MODEL 4 STYLE UT VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 3 7 34
DAMAGE YES NO YES❑ NO✓
13❑ REGISTERED OWNER INFO BAILEYBRECHT11.0146THAVESERENTONWA98059 VEHICLE NO. 1
SHADEINDAMAGED AREA ❑ 35
4 LIABILITY INSURANCE INSURANCE CO 3 4
14❑ ❑✓ NATIONAL GENERAL 2019829995
IN EFFECT &POLICY# 9TOP
LEGALLY YEs[:]NO[:] CITATION# CHARGE t t0 BOTTOM 5 36
15❑ sTANING s 6
MOT'
PEDAL- PROPERTY DAM THR OLD MET PHONE
() IT OZ �✓ ❑ PEDESTRIAN ❑ ❑ D:4254421995
VEHICLE CYCLE OWNER YES�/ NO
16
LAST NAME SAYSANASY FIRSTNAME SABRINA MIDDLE S
INITIAL
17❑ STREET ❑; 10329 16TH PL W CITY EVERETT ST I WA ZIP 98204 4❑ 37
NEW ADDRESS
18 CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED' 38
INTERLOCKYE5 NO INTERLOCKYFS No YES ND
19❑ DRIVE #
❑ ON DUTY STATUS AIRBAG 2 RESTR 9 EJECT 1 HELMET
2 INJURY
CUSS 1 NATURE OF INJURIES 40
21 LICENSE CNG1966 TATe WAN# 2HKRS4H27SH406622 41
P 1
PLATE# ❑
42
22TILER PLATE# ; STATE PLATE# STATE
23� 43
TRLR RLR
VIN#.. 'IN#.
VEH.YEAR 2025 MAKE HOND MODEL CR-V STYLE UT VEHICLE TOWED TO BLIN TOWED BY GO HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO SOMCHAI SAYASOUNTHONE 1032916TH PL W EVERETT WA 98204 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE INSURANCECO STATE FARM 5676297-C24-47
IN EFFECT &POLICY# i 9TOP 5
venue N❑ ,J—I CITATION# CHARGE
YES
25 I O BOTTOM
LEGALLY e
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
MIRIAM LONG 12790 WA0171300
PAGE 01 OF
PART A 0
3000-345-159(R 11f181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF61706
COLLISION REPORT III III III III III 111
1591972 Ci # ' 25-1002
ADDITIONAL PERSONS INVOLVED PASSENGERS AND/OR WITNESSES ONLY)
NAME
(LAST fIflST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B.
MMDDYYYY.
' HELMET INJURY'
PASSENGER WITNESS ,UNIT# SEAT AIRBAG RESTR. EJECT NATURE OF INJURIES
POS. USE 'CLASS
NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS k PHONE# DOB SEX M _F
MDDYYYY
PASSENGER WITNESS[-] UNIT# SEAT : AIRBAG RESTR. EJECT HELMET NJURY NATURE Of INJURIES
POS. USE CLASS
'.NAME
(LAST,FIRST MIDDLE INITIAL)
ADDRESS&PHONE# D O B
SEX' MMDDYYYY
PASSENGER [-i WITNESS j 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.
MIRIAM LONG 01-31-25 02:17 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY E
DAT
S.WOODWARD 11528 V212025 2:01:06 PM
BADGE OR ID# 12790 ORI# WA0171300 TIME POLICE DISPATCHED 11:17 AM TIME POLICE ARRIVED 11:21 AM
PART B�wDa-345-100(R11118) PAGE F21 OF
REPORT NO. EF61706 CASE# 25-1002 OFC COLLISION
01/31/25 11:07
OF COLLISION
NARRATIVE
Unless otherwise noted, the following occurred in the City of Renton, County of King, WA.
On 1/31/2025 at about 1117 hours I responded to a collision at NE 3rd St/Bronson Way NE.
I arrived at the location and observed both units were blocking west bound traffic in lane one on NE
3rd St. Unit#2 had damage to the front left side of the vehicle including a flat tire. Unit#1 had
damage to the front right side of the vehicle including a bent wheel.
contacted the involved parties, who were walking around and had no obvious injuries. There, I
collected the involved parties driving documents and the independent recollection of events leading
up to the collision.
The driver of Unit#1 (Morgan) said she was the sole occupant of the vehicle and that prior to the
collision she was driving east on NE 3rd St in lane two when it felt as if her passenger wheel had
come off her vehicle, which caused her to cross over the center lane where she collided with Unit#2.
The driver of Unit#2 (Sabrina) said she was the sole occupant of the vehicle and that prior to the
collision she was driving west on NE 3rd St in lane two when she saw Unit#1, who was driving east
on NE 3rd St, all the sudden come into her lane and collided with her vehicle as it was spinning all the
way around.
All involved parties exchanged information and were provided the case number.
Unit#2 required a tow as it was not drivable and blocking the roadway.
Unit#1 was driven safely off the roadway.
I certify (declare) under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Electronically signed by M Long#12790 on 1/31/2025 @ 1415 hours in Renton WA.
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REPORT NO. EF61706 CASE# 25-1002 DATE AND TIME 01/31/25 11:07
OF COLLISION
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