HomeMy WebLinkAbout25-756 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF67170OLCERA
COLLISION REPORT 1591971
❑ 0✓ FIRERES ED I
CASE# 25-756 2
INTERSTATE CITY STREET FIRE STOLENSTATE ROUTE OTHER VEHICLE LOCAI-AGENCY 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 1 TOTAL#OF OBJECT 1 28
TRIBAL i UNITS 01 STRUCK TREE OR STUMP
i RESERVATION I 1 1 2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 01 - 24 - 2025 0820 17 =.= S 8 W e OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
S PUGET DR BLOCK NO. e 1900 .�
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 2501.1 00 FEET e✓ S 8 W e✓ BENSON RD S
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2064510693 30
5 LAST NAME LE FIRST NAME THANH MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 1327 S PUGET DR APT F14 CITY; RENTON ST I WA ZIP; 980554331 2
NEW ADDRESS
7� +CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED: 3
INTERLOCKYEs NO INTERLOCKYES No vEs NO
8 DCIENSE# STATE WA SEXI M MMDDYY' 08 - 24 - 1968 32
9 ON DUTY STATUS' AIRBAG 6 RESTR 4 EJECT 1 N UET SE �JAU SY 1 [NATURE of INJURIES 2
LICENSE, CFX5002 STATE WA VIN# 5FRYD4H43GBO34952 3
10 F1 as ATP rt
TRAILER STATE TRAILER STATE ROM To 11 3 5 PLATE# PLATE#
TRLR TRLR 5 1 33
12 VIN#' VIN#
: FROM TO
13 2 VEH.YEAR 2016 MAKE ACUR MODEL MDX STYLE VEHICLE TO YED NO fj'4 IN TgAWIZLRS YoSEENp m 34
DAMAGE IIII._IIII HHttVVii((tt I_I
REGISTERED OWNER INFO pHUONG LE 1327SPUGET OR APT FI4 RENTON WA 980554331 VEHICLE NO. 1
❑ SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE NSURANCE CO TBA TBA
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 36
LEGALLY YES❑NO❑ CITATION# 70 80TTOM
15❑ ETANowc s 7 6
MOTOR PEDAL-:. PROPERTY DAM THR OLD MET PHONE
UNIT�' PEDESTRIAN
VEHICLE CYCLE' OWNER YES NO
16❑
LAST NAME FIRST NAME MIDDLE'
INITIAL
17❑ STREET ❑ CITY ST ZIP ❑ 37
NEW ADDRESS
18❑ CDL IGNITION REQUIRED IGNITION PRESENT MED[CALTRANSPORTED: 38
INTERLOCKYEs No INTERLOCK YES R No YEs NQ
19 DRIVERS
# STATE SEX MMDDYY —= 39
HELMET INJURY NATURE OF INJURIES 4Q
20❑ ON DUTY STATUS AIRBAG RESTR EJECT USE CLASSLICENSE
❑
21 PLATE# VIN# 41
TATE
22❑ [TILER TAILER
PLATE# STATE PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR MAKE MODEL STYLE VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24 DAMAGE YES NO YES NO
REGISTERED OWNER INFO VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY INSURANCE❑ INSURANCE CO
IN EFFECT &POLICY# 9TOP
YEmcLE ❑ ,.I—I CITATION# CHARGE to BOTTOM
EEGAEEY YES NC
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
M.LEVERTON 2517 WA0171300
PAGE 01 OF
PART A 3000-348-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF67170
COLLISION REPORT III III III III III 111
1591972 CASE# 25-756
E NA ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
M
(LAST,FIRST,MIDDLE INITIAL) DINGLER KURTIS
ADDRESS&PHONE#
2066020926 Ste' U MMDDDYBYYY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET INJURY NRE OF INJURIES
POS. ' USE CLASS [ATU ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYYYY D.D.B. -
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURE CFINJURIES
POS. USE CLASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX/ MMDDYY D.D.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE CLASS
NARRATIVE
Within the city limits of Renton/King/Wa I responded to a single vehicle off the roadway and into a
tree.
I contacted the driver of unit 1 who did not speak English as his primary language and mostly smiled
while 1 asked him what happened. He did not say much other than he slide off the road.
A witness on scene told me he was following unit 1 and it appeared as if unit 1/driver simply went
straight rather than negotiating the curve in the roadway. The witness said the car just went straight
and crashed into a tree, the driver got out. The witness told me he called 911.
The road is uphill wet but not icy and has a broad curve. There is nothing tricky about driving on this
particular section of the road.
Information/insurance only
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 1/24/2025
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
M.LEVERTON 01-24-25 08:47 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLACE SIGNED
APPROVED BY DATE
C.JACOBS 1953 211912025 1:41:21 PM
BADGE OR ID# ; 2517 ORI# WA0171300 TIME POLICE DISPATCHED 8:20 Aryl TIME POLICE ARRIVED i 8:22 AM
PAST B 3 Da-3mx-attar(t 1Mff) PAGE 2�OF F3
REPORT NO. E F67170 CASE# 25-756 DATE AND TIME 01/24/25 08:20
OF COLLISION
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