HomeMy WebLinkAbout25-2627 IT si " II IIIII III IIIII II IIII IIIII I . 27c REPORT NO EF76516OLCERA
COLLISION REPORT 1591971
INTERSTATE ❑ CITY STREET FIRE I
CASE# 25-2627 2
RESULTED STOLENSTATE ROUTE OTHER VEHICLE LOCALANG 4200 3
HIT&RUN CODING
COUNTY RD PRIVATE WAY INVOLVED
2 TOTAL#OF OBJECT 1 s 28
TRIBAL UNITS 02 STRUCK ❑
RESERVATION : 1 1
2
3� M M D D Y Y Y Y TIME(2400) COUNTY# MILES CITY#
eaCL s on' 03 - 23 - 2025 1335 17 =.= S 8 W❑ OF IN e 1070 s
4❑ ON (PRIMARY TRAFFIC WAY) INTERSECTION ❑✓ NON INTERSECTION ❑
BLOCK NO.
AIRPORT WAY
4a❑ MILE POST
❑ DISTANCE OF(REFERENCE OR CROSS STREET)
5 1.1 FEET e S 8 W e SHATTUCKAVES
0 1 29
MOTOR ✓ PEDAL- DAM AG THRESHOLD MET PHONE
UNIT 01 VEHICLE ❑ CYCLE ❑ YEs Vl No D:2067510604 0 6 30
6 LAST NAME FORD FIRST NAME K'LEA MIDDLE D 1 1 2 31
INITIAL
STREET ❑ 303 17TH ST SE APT 7 CITY;AUBURN ST I WA ZIP; 98002 2
NEW ADDRESS
7 COL IGNITION REQUIRED IGNITION PRESENT MEDICAL TRANSPORTED. 3
INTERLOCKYES NO✓ (NTERLOCKYEs NO✓ YES NO
8 DRIVER # STATE WA SEXI F MMDDYY' 10 - 01 - 1998 1 2 32
-NJUR
9 ON DUTY STATUS' AIRBAG 3 RESTR 4 EJECT 1 HELMET
2 CLASSY ? [NATURE of INJURIES 2❑
LICENSE, CPU6170 STATE WA VIN#; 1FMEU74E08UA08365 3
10 Fl I PI ATP tt
11 0 0 TRAILER STATE TRAILER STATE
PLATE# PLATE# ROM To
TRLR TRLR. 3 1 7 33
12 0 0 VIN#' VIN#
FROM TO
VEH.YEAR 2008 MAKE FORD MODEL EXPLOR STYLE UT VEHICLE TOWED[n TO ZBLIN TOWEDBY GOVT VEHICLE 3 7 34
13� DAMAGE YES II_II NO YESII_I) NO✓
REGISTERED OWNER INFO OWNEDBYDRIVER VEHICLE NO. 1
SHADE IN DAMAGED AREA 35
14 LIABILITY INSURANCE❑ NSURANCE CO NONE 4
IN EFFECT &POLICY# 9TOP _
Lrn Lyc ❑ ❑ 5A0362574 CHARGE OP MOT VEH W/OUT INSURANCE a oorrob z 36
Yes NO CITATION#
15❑
MOTOR ✓ PEDAL- PEDESTRIAN PROPERTY DAM THR OLD MET PHONE
UNIT O2 VEHICLE CYCLE nWNFR YES NO �/ D:2065869115
16�
LAST NAME LY FIRST NAME PATRICK MIDDLE'
INITIAL
17 F1 STREET ❑
❑ 12440 155TH AVE SE CITY RENTON ST, WA ZIP 98059 4 37
NEW ADDRESS
1$❑ CDL IGNITION REQUIRED IGNITION PRESENT MEDICALTRANSPORTED 38
INTERLOCKYES,✓NO INTERLOCK YES FZ No YES ND✓
19 DRIVER'S ' STATE WA SEX M I D.O.B. 11 05 ?993 � 39
LICENSE# MMDDYY -
20❑ ON DUTY STATUS AIRBAG 2 RESTR 4 EJECT 1 H U ET 2 INJURY ? NATURE OF INJURIES 40
CLASS
21 LICENSE I PATE# CBM7553 rare WA vIN# 2T3A1RFV7MW247669 41
22❑ PLATE# STATE[TILER I PLATE# STATE 42
23 TRLR RLR 43
UIN#. 'IN#
VEH.YEAR 2021 MAKE TOYT MODEL RAV4 STYLE UT VEHICLE TOWED TO BLIN
TOWED BY GOV HI 44
24❑ DAMAGE YES NO✓ NO✓
REGISTERED OWNER INFO OWNED BY DRIVER VEHICLEE NQ.2
SHADE IN DAMAGED AREA
2 3 4
IAEFFITY INSURANCE &.POLINSURICY# CO GRANWEST 5104440115477 VEH10LE YES❑ NC❑ CITATION# 5AO378642 CHARGE NO VALID OPER LICENSE WITH VALIDG�Da
L','—Lv
25 a s
OFFICER'S NAME(PRINT) OFFICER PHONE BADGE OR ID# AGENCY
J
26
TIMOTHY NGUYEN 13182 WA0171300
❑
PAGE 01 OF
PART A 3000-345-189(R 11/18)
STATE OF
POLICETRAFFICN CORRECTION REPORT NO. EF76516
COLLISION REPORT III III III III III 111
1591972 CASE# 25-2627
ADDITIONAL PERSONS INVOLVED(PASSENGERS AND/OR WITNESSES ONLY)
'.NAME
(LAST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEXi D.O.B. —
MMDDYYYY
PASSENGERQ WITNESS� UNIT SEAT AIRBAG RESTR. EJECT ; HELMET INJURY NATURE OF INJURIES
POS. ' USE GLASS 1 ----�
:NAME
(LAST FIRST MIDDLE INITIAL)
ADDRESS&PHONE#
SEX D.O.B. —
MMDDYYYY
PASSENGER❑WITNESS UNIT# : SEAT AIRBAG RESTR. EJECT HELMET INJURY: NATURECFINJURIES
POS. USE CIASS ----�
:NAME
(LOST,FIRST,MIDDLE INITIAL)
ADDRESS&PHONE#
SEX MMDDYY D.O.B.
YY
PASSENGER WITNESS UNIT# SEAT AIRBAG RESTR. EJECT HELMET NJURY NATURE OF INJURIES
POS. I USE GLASS
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.
TIMOTHY NGUYEN 03-23-25 05:58 PM
INVESTIGATING OFFICER'S SIGNATURE UNIT OR DIST.DET DATED PLAGE SIGNED
APPROVED BY DATE
P.KORDEL 9676 3/24/2025 3:02:49 PM
BADGE OR ID# j 13182 ORI# WA0171300 TIME POLICE DISPATCHED 1 1:38 PM TIME POLICE ARRIVED i 1:44 pryl
PAST B 3 Do-3mx—attar(t 1Mff) PAGE 2�OF 4
REPORT NO. EF76516 CASE# 25-2627 OF DATE AND r�N + 03/23/25 13:35
O�COLLISION
NARRATIVE
25-2627
During this incident, 1 was wearing an Axon body worn camera, and the incident was recorded on
video with audio. Refer to this video for any exact quotations or for an exact sequence of events. The
following is a summary of the events:
On 03/23/2025 at approximately 1344 hours 1 arrived at a collision at Airport Way and Shattuck Ave
S, within the city of Renton, King County, state of Washington. Upon arrival, I observed Vehicle 1 with
heavy front-end damage and an airbag deployment from the steering wheel. I observed Vehicle 2
with minor rear-end damage.
Both Driver 1 and Driver 2 advised that they were okay. Driver 1 had a private tow enroute.
Driver 1 reported she was driving westbound and straight in lane 3 on Airport Way. As she was
approaching Shattuck Ave S, Vehicle 2 changed lanes in front of her. Driver 1 advised that she was
unable to stop in time, and ultimately collided with Vehicle 2's rear-end.
Driver 2 reported he was driving westbound and straight in lane 3 on Airport Way. As he was
approaching Shattuck Ave S, he observed a yellow light and slowed down. At this point, Vehicle 1
collided with Vehicle 2's rear-end.
Driver 1 did not have proof of insurance. I am issuing Driver 1: IT #5A0362574 for RCW 46.30.020 -
OPERATING MOTOR VEHICLE W/O INSURANCE via mail. 1 advised Driver 1 on how to respond
appropriately.
Driver 2 was suspended in the 3rd degree. 1 am issuing Driver 2: IT#5A0378642 for RCW 46.20.015
for NO VALID OPERATOR'S LICENSE WITH VALID ID via mail. I advised Driver 2 on how to
respond appropriately.
In parting, 1 provided both drivers with my business card and case number in lieu of the on-scene
information exchange. This ends my involvement on today's date.
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
WASHINGTON THAT ALL STATEMENTS MADE HEREIN ARE TRUE AND ACCURATE AND THAT
I AM ENTERING MY AUTHORIZED USER ID AND PASSWORD TO AUTHENTICATE IT.
Signature: Officer T. Nguyen #13182
Date, Time, and Place: 03/23/2025 at approximately 1722 hours in the city of Renton, King County,
state of Washington
PAGE 3 OF 4
REPORT NO. EF76516 CASE# 25-2627 DATE AND TIME 03/23/2513:35
OF COLLISION
u rya
e
PAGE 4 OF 4