HomeMy WebLinkAbout25-2229 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 6 27c
COLLISION REP FIT 1591971
CASE 25-2229 z
INTERSTATE ❑ CITY STREET FIRE ❑
RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHICI F ❑ LOCAL AGENCI 4Y00 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 28
TRIBAL UNITS 01 STRUCK' UT/tITYPOLE
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY# ❑
GawsloN 03 - 1-- 2025 1008 17 ❑.= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑ NON INTERSECTION ❑✓
NE 4TH ST BLOCK NO. e✓ 5700
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ 250 00 FEET e S ❑ W e NILEAVENE
0 1 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2062014386 30
6� LAST NAME NGUYEN FIRSTNAME DANIEL MIDDLE T 1 F 2 31
INITIAL
STREET ❑ 1807 KITSAP PL NE CITY RENTON ST WA ZIP 98059 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO�/ YES R No�/
8❑ LRIIVER #
ON DUTY❑ STATUS AIRBAG 4 RESTR 4 EJECT 1 H U SE
ICNLJAUSSY 1 NATURE OF INJURIES z❑
3
10❑ Pi aT�S� BYH0616 sTArI WAvIN# JTHGt46F875014507
TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# FROM TO
TRLR. TRLR 7 3 33
12❑ VIN#j VIN#
FROM
34
13 $ VEH.YEAR 2007 MAKE LEXS MODEL LS 460L STYLE 4D VEHICLE TOWED 0 NOO ffBLIN TQVWkkRS y�S❑ENO
❑ DAMAGE ILJI tSA1Wl6
REGISTERED OWNER INFO SON NOUYEN 1807 KITSAP PL NE RENTON WA 98059 D:2066052000 VEHICLE NO. 1 ❑
SHADE IN DAMAGED AREA 35
3 4
14❑ LIABILITY INSURANCE INSURANCE CO AMERICAN FAMILYA101093303
IN EFFECT &POLICY# 9TOP
VEHCLE CHARGE 5 36
LEGALLY YES❑NO❑ CITATION# 10 BOTTOM
15❑ STAIN.D'ING 7
UNIT VE IOOR El CYCLE PEDAL- ❑ PEDESTRIAN ❑ OWNER
❑ DYES H OLD MET PHONE
16❑
LAST NAME FIRST NAME MIDDLE
INITIAL
STREET
17❑ NEW ADDRESS❑' CITY ST ZIP ❑ 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 LLIICENS # STATE SEX MMDDYY -�_ 39
HELMET INJURY NATURE OF INJURIES 40
20❑ ON DUTY STATUS' AIRBAG RESTR EJECT USE CLASS ❑
❑21❑ LICENSE TArE VIN# 41
PLATE#
42
22❑ PLATE# STATE PLATE# STATE
23❑ 43
TRLR RLR
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
#E CO
IN EFFECT &PO IGQVE""LE
❑ ,J� CITATION# CHARGE
LEGALLY YES N`L J
25
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
R.ON/SHl 5738 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF73302
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2229
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
POS. 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 FIRST 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'
Unit 1 eastbound in curb lane of NE 4th St; vehicle left roadway, crossed south sidewalk, and struck
utility pole (Puget Sound Energy) and fence (372 Nile PI NE). Driver and sole occupant Daniel
Nguyen told me that he had turned from northbound Nile Ave NE onto eastbound NE 4th St when
suddenly the car lost traction and spun out. Unit 1 spun clockwise before impact, striking pole and
fence on driver's side. Side curtain airbag on driver's door deployed, but Nguyen declined aid and
said that he was uninjured. Utility pole was sheared at base; owner is:
Puget Sound Energy
13230 SE 32nd St
Bellevue WA 98005
(425) 466-8561
Collision destroyed about 20' of 6' high wooden fence, and a small tree. Fence owner is:
Pham, Thao K
372 Nile PI NE
Renton, WA 98059
(206) 313-3717
I CERTIFY(DECLARE)UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
R.ONISHI 03-12-25 05:01 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 1 311312025 4:40:19 AM
BADGE OR ID# 5738 OR]# ! WA0171300 TIME POLICE DISPATCHED 10:09 AM TIME POLICE ARRIVED 10:17 AM
PART I PAGE IT]OF 3�
REPORT NO. EF73302 CASE# ' 25-2229 DATE AND TIME 03/12/25 10:08
OF COLLISION
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