HomeMy WebLinkAbout25-2270 ITFF' "POLCERA II I !�� I III I III I IIII III II I . 0 27c
COLLISION REP FIT 1591971
CASE 25-2270 z
INTERSTATE ❑ CITY STREET FIRE ❑RESULTED
1 STOLEN
STATE ROUTE ❑ OTHER ❑ VFHIC;I F ❑ LOCAL AOENC 4200 3
HIT 8 RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 3 TOTAL#OF OBJECT 1 1 8 28
TRIBAL UNITS 02 STRUCK
RESERVATION
z
3❑ DATE OF M M D D Y Y Y Y TIME(2400) COUNTY# MILES N E IN CITY#
cawsloN 03 - 1-- 2025 0431 17 ❑-= S 8 IN e 1070 3
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
RAINIER AVE S BLOCK NO. e✓ 300 ❑
4a❑ MILEPOST
DISTANCE OF(REFERENCE OR CROSS STREET)
5❑ �.❑ FEET e S ❑ VV a SW SUNSET BLVD
1 9 29
MOTOR PEDAL- DAMAGE THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE El
✓NO D:2068250808 0 11
30
6� LAST NAME NG FIRSTNAME MILTON MIDDLE C 1 2 31
INITIAL
STREET ❑, 18123 72ND AVE S CITY SEATTLE FT WA Zjp, 98032 z
NEW ADDRESS
7❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED 3
iNTERLOCKYEs NO 1/ INTERLOCKYEs NO Z/ YES R No�/
8 LRIIVERCENS # STATE SEX'M MDMDD 09 - 22 - 1995 1 2 32
9 ON DUTY❑ STATUS AIRBAG 2 RESTR 4 EJECT 1 H USEET ICNIJAU RY 1 NATURE OF INJURIES z❑
3
10 1❑ PI ATES 665MTQ sTATe OR vN# ZACPDFCW8R3A28634
5 TRAILER STATE TRAILER STATE
11 3 5 PLATE# PLATE# Rom ro
TRLR. A'RLR. 1 5 33
12 3 5 VIN#' VIN#
>; FROM TO
VEH.YEAR 2024 DODG HORNS MAKE MODEL STYLE VEHICLE TOWED TO BLIN TOWED BY GOVT.VEHICLE 5 1 34
13 4 DAMAGE YES NO YES❑ NO✓
REGISTERED OWNER INFO PV HOLDING CORP 1555 NE AIRPORT WA Y PORTLAND OR 97220 D:2064335231 VEHICLE NO. 1
❑ ❑
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE INSURANCE CO AVIS RENTAL 910838342 3 4
IN EFFECT &POLICY# 9TOP
VEHICLE CHARGE 5 36
LECALLv Yes❑NO❑ CITATION# 10 BOTTOM
15❑ STANDING 8 7 6
MOTOR PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT 02 VEHICLE ❑ CYCLE ❑ ❑ OWNER ❑ YES 1/ NO D:2069152994
16 a
LAST NAME CISSE FIRST NAME OMAR MIDDLE N
INITIAL
17 STREET❑ NEW ADOREss❑' 18663 129TH PL SE CITY RENTON ST WA ZIP 980587972 4❑ 37
18❑ CDL IGNITION REQUIRED IGNITION PtR—E—S1ENT MEDICAL—T�RANSPORTED � 38
INTERLOCK YEs❑No� INTERLOCK YEs I I NOF YES
t l NO/
19 LDICENSEIVERI # STATE WA SEX M MMDDYY 11 10 _ 1993 39
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 HEJ EET NJAU EY 1 NATURE OF INJURIES ❑ 40
❑21❑ PLATE# CLX8713 TATE 41
WA VIN# JTDKN3DU5F0446176 1
42
22❑ PLATE# STATE PLATE# STATE
TRLR
23❑ UIN#. IN#.
43
RLR
'
VEH YEAR 2015 MAKE TOYT MODEL PRIUS STYLE VEHICLETOWED TO BLIN TOWEDBY GOV HI 44
L4❑ DAMAGE YES NO YES NO
REGISTERED OWNER INFO OMAR CISSE 2119 DUVALL AVE NE RENTON WA 98059 D:2069152994 VEHICLE NO.2
SHADE IN DAMAGED AREA
2 3 4
LIABILITY
INSURANCE INSU PORGY#E CO BRISTOL WEST G015868197 00IN
VEHICLE ❑ ,.I—I CITATION# CHARGE C�Ql
LEGALLY YES N`LJ
25 —TA
s � e
7p-,
S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
26
TAGNE 12575 WA0171300
PART A PAGE 01 OF C7
3000-345-159 OR 11/181
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF74472
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2270
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 FIR57 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'
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.
P.LANTAGNE 03-13-25 11:10 AM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST DET DATED PLACE SIGNED
APPROVED BY DATE
D.SKELTON 9139 311712025 3:57:16 AM
BADGE OR ID# 12575 OR]# ! WA0171300 TIME POLICE DISPATCHED ¢:31 AM TIME POLICE ARRIVED¢:31 AM
PART I PAGE IT]OF 4�
REPORT NO. EF74472 CASE# 25-2270 OF COLLISION
03/13/25 04:31
OF CbLLI510N
NARRATIVE
25-2270
On 03/13/2025 at approximately 0431 hours, I, Officer Lantagne, observed a blocking, non-injury
collision which occurred in the 300 block of Rainier AVE S, which is located in the City of Renton,
County of King, and the State of Washington. I was in my fully marked police vehicle, wearing my
patrol uniform and body worn vehicle.
I observed Unit#1, a 2024 Dodge Hornet with license plates 665MTQ issued out of Oregon, and Unit
#2, a 2015 Toyota Prius with license plates CLX8713 issued out of Washington State, blocking the
northbound left turn lane of Rainier AVE S onto SW Sunset BLVD. Unit#1 was facing southbound in
the northbound lanes of travel.
I contacted the driver of Unit#1, Milton C. Ng (DOB 09/22/1995), who told me the following: Ng was
driving southbound on Rainier AVE S. Due to the heavy rain and poor vision, Ng crossed over to the
oncoming lanes of travel while going through the intersection and the front of his vehicle struck the
front of Unit#2. Ng provided me with a driver's license, license number S9533544F, issued out of
Singapore.
I contacted the driver of Unit#2, Omar Cisse (DOB 11/10/1993), who told me the following: Cisse
was waiting to make a left turn from northbound Rainier AVE S onto westbound SW Sunset BLVD.
While waiting for the light to change, Unit#1 drove into Cisse's lane and struck the front of his
vehicle.
I observed the damage to the vehicles and other physical evidence was consistent with the
statements made by both parties. Unit#1 had significant damage to the front bumper which was
pushed into the radiator. Unit#2 had similar damage to Unit#1.
The collision diagram is an accurate illustration of the events leading up to the collision.
I provided an exchange of information to Ng and Cisse.
I, Officer P. Lantagne #12575, certify (or declare) under penalty of perjury, under the laws of the State
of Washington, the foregoing is true and correct.
Electronically signed by Officer P. Lantagne #12575 at 1055 hours on 03/13/2025 at Renton, WA.
**** AUTO-POPULATED SECTION ****
THE FOLLOWING ARE DESCRIPTIONS ENTERED FOR ITEMS SELECTED AS "OTHER":
Motor Vehicle Unit 1
Action Code: DRIVING INTO ONCOMING LANE OF TRAVEL
**** END OF AUTO-POPULATED SECTION ****
PAGE 3 OF 4
REPORT NO. EF74472 CASE# 25-2270 DATE AND TIME 03/13/25 04:31
OF COLLISION
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